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Please Copy & Paste this application into an email and submit it to the email address at the bottom of this page. Someone will respond to your application within 72 hours of receiving the completed form. We are working on making this application a form so please be patient if you experience any problems.
Wisconsin Chinchilla Rescue Adoption Application
Full Name of Applicant Applicants Date of Birth
Full Name of Spouse/Other Household Adult Date of Birth
Street Address
City State Zip
Is the residence located in a Town Village City
What County do you reside in
Home Phone Cell Phone
Is your mailing address the same as the Street Address Yes No
Mailing Address if different then Street Address
Is this Residence a House Apartment Mobile Home Farm
Other (Explain)
How long have you lived at the above address
If less then 3 years, Previous Address
Do you : Own Rent Land Contract Live with parents/relatives
If Owned, who is the property listed under
If Rental, Please list land owners name and phone number
Applicants Drivers License Number
Other Adults Drivers License
Email Address Applicants Employers Name
Address of Employment
Phone Number Length of Employment
Spouses Employers Name
Address of Employment
Phone Number Length of Employment
How many Adults live in Household: Children Ages
Do All Adults Agree on Adopting a Chinchilla Yes No If No, Why Not:
Does Anyone in the Household have Allergies Yes No If Yes, to what:
Do you have a Preference as to Color/ Sex/ Age Yes No If Yes, State
Will this be the First time Owning a Chin Yes No
Have you done any research on Chins and their special needs Yes No
If Yes, Explain
Who will be responsible of the daily care of the chin
Where will the Pet be Kept during the Daytime
And at Night
How will the Chin be exercised
Have you Ever taken an animal to a Shelter Yes No If Yes, Explain
Have you Previously Adopted a Pet from a shelter Yes No
Name of Shelter City
Date of Adoption Do you still have the pet Yes No
If No, Explain
If the Chin becomes Ill and needs Veterinary Care, Can you afford to pay for the necessary Medical Treatment and are you willing to do so Yes No
If No, Why Not
It may take Several Weeks or Longer for the Adopted Chin to Adjust to your Home and Other Pets. Are you willing to be Patient and Allow Time for the Adjustment Period Yes No If No, Explain
If your Circumstances Change for Any Reason, Who would be Responsible for the Chinchilla
Are you Willing to Take the Animal with you if you Move Yes No
If No, Explain
What Pets Do you Currently Have in the Household
Name of Veterinarian/Clinic
Address
Phone Number
Are your Current Pets Up to Date on Vaccinations Yes No Unsure
WE WILL NOT KNOWINGLY PLACE AN ANIMAL IN A SITUATION WHERE ITS WELL BEING IS QUESTIONABLE. THEREFORE, WE RESERVE THE RIGHT TO REFUSE AN ADOPTION APPLICATION. NO ANIMAL WILL BE ADOPTED TO PROSPECTIVE OWNERS WHO MISLEAD OR FAIL TO PROVIDE COMPLETE AND ACCURATE INFORMATION ON THIS ADOPTION APPLICATION.
Applicants Signature Date
Co Applicants Signature Date
Rescue Representative
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