Filling out an application does not place any holds on a pet. Pet(s) Applying For:(Required) (Required) Cat Dog Applicant(s) Names(s) and age(s):(Required) Ages of other people in the home (including children):(Required) Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County(Required) How long have you lived here?(Required) Own or Rent(Required) Own Rent Landlord Name and Phone:(Required) Home(Required) Single Family Home Apartment/Condo Other Please explain type of home:(Required) Fenced Yard?(Required) Yes No Fence Height & Material(Required) Other pets in the home (include ages)(Required)All current pets fixed?(Required) Yes No No current pets If "No", please explain: Are your current pets indoor, outdoor, or both? How many other pets have you had in the past 5 years and why are these pets no longer with you?(Required)Have you adopted a pet from us or another rescue before?(Required) Yes No Name of adopted pet(s)? Have you surrendered a pet to us or another rescue before?(Required) Yes No Why did you surrender the pet? Will your new pet be kept indoor, outdoor, or both?(Required) Where will the new pet sleep?(Required) How long will your pet be left alone in the home each day?(Required) I agree:(Required) I certify that all information provided on the Adoption Application is complete and true. I understand that any false information will nullify the adoption and result in the return of my pet to NAS without any refund or exchange.Name(Required) First Last Date(Required) MM slash DD slash YYYY
