Apply to Adopt Online Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Primary Phone*Type* Home Cell Work Secondary PhoneType Home Cell Work Other pets living with you now (species, spayed/neutered, ages)List all humans in the household and agesWhere will dog be during the day? Please be specific.Where will dog be during the night? Please be specific.Do you own or rent?*OwnRentIf rent, landlord's phone number*Do you have a yard?*YesNoIf yes, is it fenced and what type?*Which dog do you want and why?*Will you allow a home visit?*YesNoOther Information that you think might be helpful for us to know:Veterinarian Name*Veterinarian PhonePersonal Reference Name*Personal Reference Phone*How did you hear about us?