Name of Organization

Website

http://

Year founded

Governing Board

Please indicate what each individual is responsible for and include contact information.

Please describe your facility.

How many animals are at your facility?

What species does your organization work with?

Please describe your education programs (if applicable).

Describe what medical care you perform at your facility.

Describe your organization's policy on euthanasia, when necessary.

What is your organization's policy on routine veterinary care?

Example: annual exams, vaccines, spay/neuter, etc.

List any veterinarians you currently work with.

Does your organization breed or sell wildlife or exotic animals?

Please describe your organization’s activities and accomplishments over the past year

Please describe your organization’s goals for the coming year.

Is there anything else we should know?

To the best of my knowledge, all information presented here is accurate and complete.

I agree

Name of person completing this application

First Name

Last Name

9330 Waldemar Road Indianapolis, IN 46268

317-879-8633