Testing StylerJune 14, 2014 By StephenWhich dog are you interested in?*We know them by NAME not by a numberDog Breed (select "Other" if interested in multiple dogs)*Please select from listAkitaAlaskan MalamuteAustralian Cattle DogBasenjiBasset HoundBeagleBelgian MalinoisBernese Mountain DogBichon FriséBloodhoundBorder CollieBoston TerrierBoxerBoykin SpanielBrussels GriffonBull TerrierBulldogBullmastiffCairn TerrierCane CorsoCavalier King Charles SpanielChihuahuaChinese Shar PeiChow ChowCocker SpanielCollieCoonhoundCorgiDachshundDoberman PinscherFox TerrierFrench BulldogGolden RetrieverGreat DaneGreat PyreneesGreyhoundHavaneseIrish SetterIrish WolfhoundItalian GreyhoundLabrador RetrieverLhasa ApsoMalteseMastiffMiniature PinscherNewfoundlandNorwegian ElkhoundOld English SheepdogOtherPapillonPekingesePit BullPointerPomeranian, ToyPoodlePugRat TerrierRetrieverRhodesian RidgebackRottweilerSchipperkeSchnauzerSetterSheltie/Shetland SheepdogShepherdShih TzuSiberian HuskySpringer SpanielSt. BernardStaffordshire TerrierTerrierVizslaWeimaranerWhippetYorkshire TerrierOtherYour Name* First Last Address*City*State of Residence*State of ResidenceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCounty of Residence*Select CountyAdamsAllenBartholomewBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDe KalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLa PorteLagrangeLakeLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushSt. JosephScottShelbySpencerStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitleyCounty of Residence*Select CountyAdairAllenAndersonBallardBarrenBathBellBooneBourbonBoydBoyleBrackenBreathittBreckinridgeBullittButlerCaldwellCallowayCampbellCarlisleCarrollCarterCaseyChristianClarkClayClintonCrittendenCumberlandDaviessEdmonsonElliottEstillFayetteFlemingFloydFranklinFultonGallatinGarrardGrantGravesGraysonGreenGreenupHancockHardinHarlanHarrisonHartHendersonHenryHickmanHopkinsJacksonJeffersonJessamineJohnsonKentonKnottKnoxLarueLaurelLawrenceLeeLeslieLetcherLewisLincolnLivingstonLoganLyonMcCrackenMcCrearyMcLeanMadisonMagoffinMarionMarshallMartinMasonMeadeMenifeeMercerMetcalfeMonroeMontgomeryMorganMuhlenbergNelsonNicholasOhioOldhamOwenOwsleyPendletonPerryPikePowellPulaskiRobertsonRockcastleRowanRussellScottShelbySimpsonSpencerTaylorToddTriggTrimbleUnionWarrenWashingtonWayneWebsterWhitleyWolfeWoodfordCounty of Residence*Select CountyAdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFayetteFranklinFultonGalliaGeaugaGreeneGuernseyHamiltonHancockHardinHarrisonHenryHighlandHockingHolmesHuronJacksonJeffersonKnoxLakeLawrenceLickingLoganLorainLucasMadisonMahoningMarionMedinaMeigsMercerMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaPauldingPerryPickawayPikePortagePreblePutnamRichlandRossSanduskySciotoSenecaShelbyStarkSummitTrumbullTuscarawasUnionVan WertVintonWarrenWashingtonWayneWilliamsWoodWyandotZipcode*Primary Phone Number*Secondary Phone Number (if applicable)Alt Phone (if applicable)Email* Enter Email Confirm Email What is your age?*What is your age (not used)Please enter a number greater than or equal to 0.Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you live in a:*HouseApartmentTownhouseCondoDo you rent, lease or own your home? (If your name is not listed as the owner of the property, select Rent or Lease. We will verify your residency.)*RentLeaseOwnLandlord/Property Owner Name (We will seek landlord approval to place a SAAP pet in your home.)If you are not the property owner we will need your landlord information.Landlord PhoneDo you have an HOA?*YesNoHOA name:HOA phone:QuestionaireHave you ever given up an animal?*YesNoIf yes, why and where did you take it?Have you ever been issued a citation for your pet or had to reclaim your pet from the animal control/shelter?*YesNoIf yes, please explainAre there children in your home?*YesNoWhat are their ages?List any previous and current pets. Pet 1 Name:*Pet 1 Type (Dog, Cat, etc.):Pet 1 Gender:FemaleMalePet 1 Health Conditions or Cause of Death:Was Pet 1 spayed/neutered?YesNoIf yes, where:Is Pet 1 up to date on vaccinations?YesNoDo you have a second current/previous pet to add?YesNoPet 2 Name:Pet 2 Type:Pet 2 Gender:FemaleMalePet 2 Health Conditions or Cause of Death:Was Pet 2 spayed/neutered?YesNoPet 2 spay/neuter: If yes, where?Is Pet 2 up to date on vaccinations?YesNoDo you have a third current/previous pet to add?YesNoPet 3 Name:Pet 3 Type:Pet 3 Gender:FemaleMalePet 3 Health conditions/cause of death:Is Pet 3 spayed/neutered?YesNoPet 3 Spay/Neuter: If yes, where?Is Pet 3 up to date on vaccinations?YesNoDo you have a fourth current/previous pet to add?YesNoPet 4 Name:Pet 4 Type:Pet 4 Gender:FemaleMalePet 4 Health conditions/cause of death:Is Pet 4 spayed/neutered?YesNoPet 4 spay/neuter: If yes, where?Is Pet 4 up to date on vaccinations?YesNoDo you have any additional pets to add?YesNoPlease list any additional pets' names, types, gender, health conditions, whether they are spayed/neutered, and if they are up to date on vaccinations.When you are NOT HOME, where will your pet stay?*Indoors with access to go outsideIndoors with free roam of houseIndoors in a crateOutside with access to indoor area/shelterStrictly OutdoorsOtherPlease explain your answer with as much information as possible.Where will the pet stay during the day?*Where will the pet stay during the night?*Will your pet be crated?*NoYesIf you answered YES to crating your pet, please give a description on how and when the dog will be crated. If you answered NO to crating your pet, where do you plan to keep your pet while away from the home, especially while potty training?*Does your home have a pet/dog door?*YesNoIf yes, will the pet have access to the pet/dog door when you are not home?YesNoPlease describe when your pet would have access to the pet door and how monitor their time outside*How many hours per day will the pet be left alone?*Hours012345678910111213+Do you have a fenced yard?*YesNoIf YES, what type and size? If NO, how do you plan to keep the dog in your yard?*How many stairs do you have to get to your yard?*Please describe the method you plan to use to housebreak the dog. (frequent trips outside, pads, bell, etc)*If you have to move, what would you do with your adopted pet?*What circumstance would you have to surrender your pet? Divorce? New baby? allergies? aggression? housebreaking issues?*Are you ready for a possible 20 year commitment?*YesNoHave you ever taken a dog through obedience class? Do you plan to take this one?*Can you financially afford the Veterinarian costs for your new pet? Emergency Costs?*YesNoYour current Vet and phone number:*What energy level are you looking for in a pet?* High Medium LowPlease list the activities you plan on doing with your dog.*Please list at least 2 references: Please include first and last name and phone number.*Other Information or comments:Untitled This iframe contains the logic required to handle Ajax powered Gravity Forms.