Adoption Application Fill Out The Form BelowDate of Application* MM slash DD slash YYYY Is there a specific animal you are interested in adopting?* Yes No If yes:What are you looking for?Type*First ChoiceSecond ChoiceThird ChoiceAge*First ChoiceSecond ChoiceThird ChoiceSize*First ChoiceSecond ChoiceThird ChoiceAny Specific Requirements?Adopter InformationFirst Name* Last Name* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Address* Best contact phone number*Secondary or emergency phone*Number of adults living in pets new home*Number of minors and ages* Place of employment* Hours worked each week* Please describe your residence*HomeApartmentTownhomeDo you own or rent your home?*OwnedRentIf renting, please complete below:landlord/rental agency name* Phone number*Are you a veteran?* Yes No Does anyone in your house have an allergy to dogs or cats?* Yes No In general, where will your pet be during:The day?* The night?* How long will your pet be alone each day?* If a cat:Is it your intention to have this cat declawed? Yes No Will you be keeping the cat indoors at all times? Yes No If a dog:Would you be willing to enroll it obedience classes? Yes No When outdoors, my dog will be:On a leashIn a fenced yardNot on a leashWhat type of outdoor shelter will be provided?* Are any other animals at the property where the pet will live?* Yes No If yes, please describe the name, breed, age and sex of each animal. Please also note if they are spayed/neutered.*Have many animals have you had in the past five years? What happened to them?*Reference InformationVeterinarian or clinic?* Phone number with area code* Non-family member* Phone number with area code* Where did you hear about Nate's Animal Rescue?*Adoption AgreementBy acknowledging below, I certify that the information I gave is true and that any misrepresentations of the fact may result in my losing the privilege of adopting a companion animal from Nate's Animal Rescue. I understand that all adoption fees are non-refundable.Please verify that you read the above statement* Yes No CAPTCHA