| Rescue Pre-Screening and Application |
| Rescuer's Information |
| Name: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Home Phone: |
Mobile Phone:
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| Email Address: |
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| Age: |
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| Marital Status: |
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| Work Information |
| Do you work? |
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| Occupation: |
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| Company: |
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| Work Phone: |
Ext.
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| Supervisor's Name |
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| Hours per week |
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| Family & Home Information |
| Children living with you |
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| Ages of children |
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| Who will be responsible
for your sugar gliders? |
Other:
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| Your residence is: |
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| Residence Type: |
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| If renting, does your lease allow for pets? |
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| Choose one: |
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| If Currently you have pet(s),What do you have? |
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| Do you breed? |
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| If Yes,USDA License #: |
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| How long have you had pets? |
sugar gliders?
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| If you had pets BEFORE Did you breed ?: |
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| Where is the pet now? |
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| Veterinarian Info (Name, Address) |
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| Phone: |
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| Reference 1: |
| Name: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Phone: |
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| Reference 2: |
| Name: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Phone: |
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| What do you think makes you a good candidate for a USGN Certified Rescuer? |
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