North Central Indiana Spay & Neuter at Crystal Creek Kennels

Adoption Application

Name*:
Phone*:
Address*:
City*:
State*:
Zip code*:
E-mail Address*:
Do you have a fenced in yard? If so, please describe the fence and size of yard.:
If no fenced yard, what provisions are there to protect and control your dog during exercise and potty breaks?::
What kind of pets do you currently have in your home? Please include breeds, ages. :
Are your pets spayed and neutered?:	Yes No
Are your pets up to date on their shots?:	Yes No
Name and Phone number of current veterinarian. *:
Where did you get your pets?:
Do you have children?:	Yes No
If yes, please list ages of children.:
How many adults in the home? Names? Are all members in favor of adopting a pet?:
Who will be the primary caregiver for this pet?::
List your last 3 pets and the reason they are no longer with you.::
Why have you chosen to adopt a pet? (check all that apply):	Companionship Breeding Protection For Children Company for other pet
What characteristics do you desire in a pet?:	active mellow lap dog good with dogs good with cats good with children independent constant companion no shedding
How long each day will your pet be left alone?:
Please describe any experience you have with obedience training or other training. :
Where will the pet be kept when you are not at home?*:
Which dog are you interested in adopting?:

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