* indicates required

Your Name *

Telephone #

Email *

Rabbit Name *

Breed(s) *

Color(s) *

Does this rabbit have a microchip?
YesNo
If yes...
What is the number

Birthdate/Age * (may be estimated)

Weight

Sex *
FemaleMaleDon't know

Size *
SmallMediumLargeExtra-large

Is the rabbit spayed/neutered? *
YesNoDon't know
If yes...
Surgery Date

Name of Clinic

Name of Veterinarian

Intake Date (the date this rabbit left their previous guardian and entered into Rabbit Advocates care) *

**Attach Relinquishment Form if you have one

Relinquishment Reason/Rescue Story *

Bio

Cats OK
Dogs OK
Kids OK

Any other restrictions?

Any special needs?
YesNo
If yes...
Explain

Anything else?

Photos
Guidelines for photos:
Max size 5 MB
No humans in photo; clean surroundings; simple background
We can help! Let us know if you would like a bunny photo shoot.