* Name

* Address

Address2

* City

* State

* Zip

* Home Phone

Work Phone

* Email

* # Adults in Household

* # Children in Household

Children's Ages

* Who will be the primary caretaker of the animals?

* Do you own or rent your home?

If you answered 'rent,' enter your landlord's phone number

* Is anyone in the household allergic to rodents?

* Have you ever owned a pocket pet before?

If so, how long ago?

What kind and how many?

* Have you ever had to give away a pet?

If so, please explain:

What pets do you currently have? (types and sex)

* Are they spayed/neutered?

* How much time per day do you plan to spend with this new pet?

* Are you looking for a companion for an existing pet?

* Are you prepared to spend the time necessary to properly introduce and accustom your current pets to the new pet?

* Are you prepared to house the new pet separately should they not get along with your present pets?

* What kind of cage setup do you have?

* What type of bedding are you currently using or do you plan to use?

* What type of diet are you currently using or do you plan to use?

* How do you plan to give your new pet(s) out of cage time?

* How often?

* Do you currently have a veterinarian?

* If so, vet's name:

* How much do you plan to budget per year for basic care for this animal?

* How much do you plan to budget per year for veterinary care for this animal?

Please check any topics you would like to discuss with an adoption counselor.

List other topics you would like to discuss:

* Verify

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