Creekside Adoption Form

Adoption Application

Thank you for your interest in adopting!
11791 North County Road 800 E
Roachdale, Indiana 46172 USA
www.creeksiderescue.org
CreeksideRescue@gmail.com
317.946.1316
Adoptable Pet Information*
If you are not applying for a specific pet, list the type of pet and your needs. (Ex. kid friendly dog under 50 lbs)
Your Legal Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Preferred method of contact:

CallTextEmail
Home and Pet Information

This section helps us learn about your lifestyle and what animals will fit best in your home
Please list the full names and ages of everyone in the home*
Please ensure every household member is aware of and okay with adding an animal to the home.
Please list the name of your current employer and how long you have worked for them Employment Information*
Do you rent or own your current residence?*

OwnRent
How long have you lived at your current address?*
What kind of fence do you have?*

No fence4ft chainlink6ft+ chainlink4ft privacy6ft+ privacyInvisible fenceOther
If you rent please list the landlord or rental company name, contact information and any breed restrictions or weight limits that apply. If you will be using an ESA letter please have a copy ready to show a Creekside Representative.
Please list all current and previous pets owned in last 5 years.
Type of companion animal you are seeking? (Check all that apply)*

PuppyAdult DogSenior DogKittenAdult CatSenior CatOther
Why are you looking to adopt a new pet?*
How do you plan to exercise and enrich your new pet?*
What training style or tools do you plan to use with your new pet?*
Do you intend for your adopted pet to be an indoor or outdoor pet? All questions must be answered.
Indoor    Outdoor    Both
If both, please explain when and why this animal will be outside (excluding walks, potty breaks, activities with you)   Type here
What is the longest duration you will leave your pet alone?
What's the longest duration you'll leave your pet unattended outside?Type here
Where will your pet sleep at night? Type here
Where will your pet stay and who will care for them when you are unable?   Type here
Personal Reference 1 (Reference should not currently be living with you) *

Name and Relation to youPhone Number
Personal Reference 2 (Reference should not currently be living with you) *

Name and Relation to youPhone Number
Veterinarian: Name, Phone or Address*

NamePhone or Address
Do you plan to declaw, dock tails, crop ears or do any cosmetic procedures to your new pet?*

YesNo
If intending to do any cosmetic procedures we respectfully ask you NOT to adopt one of our animals as we believe cosmetic procedures are inhumane. We prohibit all cosmetic procedures on any animal adopted from Creekside Animal Rescue Inc. Do you agree not to perform any cosmetic procedures on your new pet?*

YesNo
Signature*

Clear
By signing above, I agree that all information provided is accurate and current.
Date*

MonthDayYear
Should be Empty:

Adoption Application

Home and Pet Information