Adoption Questionnaire Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Phone*Do you own or rent your home?*OwnRentHave you owned a dog before?*YesNoThe last time I had a dog was **10+ years ago2-10 years agoNot currently, but within the last yearI currently have a dogNeverI need a dog who gets along with other dogs*NoYesIf you answered yes to the previous question, please list the names, ages, genders and breeds:*My dog needs to be good with (check all that apply)* Children over 8 years of age Children under 8 years of age Elderly Cats Animals other than dogs and cats My dog will primarily be*An indoor dogAn outdoor dogHow many hours per day will your dog spend outside?*What kind of collar/harness will you use to walk your dog?*Simple leash and collarSlip collarMartingale collarHead halterPinch collarHarnessMy dog will be alone each day for:*2 hours or less4 hours or less4-8 hours8-10 hours12 hoursWhen I'm at home, I want my dog to be at my side*The majority of the timeSome of the timeLittle of the timeWhen I'm not home, my dog will spend the majority of the time*In the garageIn the yardIn a crate in the houseConfined to one room in the houseLoose in the houseI want a guard dogYesNoI want my dog to hunt or herd with me*YesNoI want my dog to be very enthusiastic in the way it loves people*Not at allSomewhatVeryI want my dog to be playful*Not at allSomewhatVeryI want my dog to be laid back*Not at allSomewhatVeryI am comfortable doing manner correction training*NoneSomeVeryI want to participate in Agility, Flyball, or Obedience classes with my dog*YesNoI'm interested in a dog with special needs (medical or behavioral)*YesPossiblyNoIt's most important to me that my dog:Please provide us with your current/previous vet's name and phone number.Phone Number*Please provide us with two personal references and your relationship to them. First Reference:*Phone Number*Second Reference:*Phone Number* This iframe contains the logic required to handle Ajax powered Gravity Forms.