Dog Adoption Application - Dauntless Animal and Wildlife Rescue

226 days ago

Description

Thank you for your interest in our wonderful dogs!
Please note that it may take one to two business days for us to respond.
We truly appreciate your interest, and we promise to get back to you as quickly as possible.

<div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1786635720295">Full Legal Name</label><span>*</span><input type="text"  name="text-1786635720295" placeholder="Full Legal Name" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1786635767963">Phone Number</label><span>*</span><input type="text"  name="text-1786635767963" placeholder="Phone Number" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1786635767821">Email</label><span>*</span><input type="text"  name="text-1786635767821" placeholder="Email" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="datePicker"><div class="form-group"><label for="datePicker-1786635790037">Birthday</label><span>*</span><div class="input-group f-b-date-timePicker"><div data-related-id="datePicker-1786635790037" class="fake-input form-control date-time-picker" data-date-format="m/d/Y"><span class="s123-calendar-handler-placeholder">Birthday</span></div><input type="hidden" data-id="datePicker-1786635790037" name="datePicker-1786635790037" value="" required data-msg-required="This field is required."><span class="input-group-addon f-b-date-timePicker-icon s123-calendar-handler-icon"><i class="svg-m s123-icon-converter " data-icon-name="calendar" style=" mask: url('https://images.cdn-files-a.com/ready_uploads/svg/calendar.svg?v=3'); -webkit-mask: url('https://images.cdn-files-a.com/ready_uploads/svg/calendar.svg?v=3');" data-ie11-classes="" alt="calendar">&nbsp;</i></span></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1786635767419">Home Address</label><span>*</span><input type="text"  name="text-1786635767419" placeholder="Home Address" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1789608358266">How long have you lived at your current address?</label><span>*</span><input type="text"  name="text-1789608358266" placeholder="How long have you lived at your current address?" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1789605156378">Rent or Own</label><div class=""><input type="radio" id="radio-group-1789605156378-0"  value="Rental" name="radio-group-1789605156378[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605156378-0" class="radio-label">Rental</label><br><input type="radio" id="radio-group-1789605156378-1"  value="Own" name="radio-group-1789605156378[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605156378-1" class="radio-label">Own</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1789605221616">If you rent, are you allowed to have animals?</label><div class=""><input type="radio" id="radio-group-1789605221616-0"  value="Yes" name="radio-group-1789605221616[]" class="">&nbsp;<label for="radio-group-1789605221616-0" class="radio-label">Yes</label><br><input type="radio" id="radio-group-1789605221616-1"  value="No" name="radio-group-1789605221616[]" class="">&nbsp;<label for="radio-group-1789605221616-1" class="radio-label">No</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1789605291974">If renting: Landlord information, name and number</label><textarea  name="textarea-1789605291974" placeholder="If renting: Landlord information, name and number" class="form-control" rows="3"></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="file"><div class="form-group"><label for="file-1786636083542">If renting: Copy of lease agreement</label><input type="file"  name="file-1786636083542" placeholder="If renting: Copy of lease agreement" class="form-control"></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1789605413933">Home Type</label><div class=""><input type="radio" id="radio-group-1789605413933-0"  value="single-story home" name="radio-group-1789605413933[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605413933-0" class="radio-label">single-story home</label><br><input type="radio" id="radio-group-1789605413933-1"  value="multiple story home" name="radio-group-1789605413933[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605413933-1" class="radio-label">multiple story home</label><br><input type="radio" id="radio-group-1789605413933-2"  value="apartment" name="radio-group-1789605413933[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605413933-2" class="radio-label">apartment</label><br><input type="radio" id="radio-group-1789605413933-3"  value="townhouse" name="radio-group-1789605413933[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605413933-3" class="radio-label">townhouse</label><br><input type="radio" id="radio-group-1789605413933-4"  value="other" name="radio-group-1789605413933[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605413933-4" class="radio-label">other</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1789605488817">Do you have a fenced in backyard?</label><div class=""><input type="radio" id="radio-group-1789605488817-0"  value="Yes" name="radio-group-1789605488817[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605488817-0" class="radio-label">Yes</label><br><input type="radio" id="radio-group-1789605488817-1"  value="No" name="radio-group-1789605488817[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605488817-1" class="radio-label">No</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1786636132705">Employer, name, address, and phone number and status (full time, part time, work from home, student, unemployed/ retired), how long have you been employed</label><span>*</span><textarea  name="textarea-1786636132705" placeholder="Employer, name, address, and phone number and status (full time, part time, work from home, student, unemployed/ retired), how long have you been employed" class="form-control" rows="5" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1786636164230">Names and ages of all people living in the home</label><span>*</span><textarea  name="textarea-1786636164230" placeholder="Names and ages of all people living in the home" class="form-control" rows="5" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1789605540571">Does anyone in the home have any allergies to pets?</label><div class=""><input type="radio" id="radio-group-1789605540571-0"  value="Yes" name="radio-group-1789605540571[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605540571-0" class="radio-label">Yes</label><br><input type="radio" id="radio-group-1789605540571-1"  value="No" name="radio-group-1789605540571[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789605540571-1" class="radio-label">No</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1786636257791">Please list all current animals in the home, including name, age, gender, and spayed or neutered</label><span>*</span><textarea  name="textarea-1786636257791" placeholder="Please list all current animals in the home, including name, age, gender, and spayed or neutered" class="form-control" rows="5" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1789605769529">Vet Information (&quot;NA&quot; if you do not have a current vet)</label><span>*</span><textarea  name="textarea-1789605769529" placeholder="Vet Information (&quot;NA&quot; if you do not have a current vet)" class="form-control" rows="4" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1786636258793">Have you ever…  1. Euthanized a pet 2. Lost a pet to an accident 3. Rehomed a pet ... Please explain why if you answered YES to any of the above</label><span>*</span><textarea  name="textarea-1786636258793" placeholder="Have you ever…  1. Euthanized a pet 2. Lost a pet to an accident 3. Rehomed a pet ... Please explain why if you answered YES to any of the above" class="form-control" rows="5" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1786636344890">Have you ever owned a dog before?</label><div class=""><input type="radio" id="radio-group-1786636344890-0"  value="Yes, I&#039;ve personally had a dog before" name="radio-group-1786636344890[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636344890-0" class="radio-label">Yes, I&#039;ve personally had a dog before</label><br><input type="radio" id="radio-group-1786636344890-1"  value="No" name="radio-group-1786636344890[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636344890-1" class="radio-label">No</label><br><input type="radio" id="radio-group-1786636344890-2"  value="My family had a dog before" name="radio-group-1786636344890[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636344890-2" class="radio-label">My family had a dog before</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="checkbox-group"><div class="form-group"><label for="checkbox-group-1789606175960">What is your purpose in adopting this dog?</label><div class=""><label for="checkbox-group-1789606175960-0" class="checkbox-label"><input type="checkbox" id="checkbox-group-1789606175960-0" value="Companionship" name="checkbox-group-1789606175960[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Companionship</span></label><br><label for="checkbox-group-1789606175960-1" class="checkbox-label"><input type="checkbox" id="checkbox-group-1789606175960-1" value="Guard dog" name="checkbox-group-1789606175960[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Guard dog</span></label><br><label for="checkbox-group-1789606175960-2" class="checkbox-label"><input type="checkbox" id="checkbox-group-1789606175960-2" value="Companion for kids" name="checkbox-group-1789606175960[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Companion for kids</span></label><br><label for="checkbox-group-1789606175960-3" class="checkbox-label"><input type="checkbox" id="checkbox-group-1789606175960-3" value="Companion for current pet" name="checkbox-group-1789606175960[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Companion for current pet</span></label><br><label for="checkbox-group-1789606175960-4" class="checkbox-label"><input type="checkbox" id="checkbox-group-1789606175960-4" value="Gift" name="checkbox-group-1789606175960[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Gift</span></label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1789606294397">Please describe your home</label><span>*</span><textarea  name="textarea-1789606294397" placeholder="Please describe your home" class="form-control" rows="5" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="number"><div class="form-group"><label for="number-1786636454668">How many hours a day will this dog be left alone?</label><span>*</span><input type="number"  name="number-1786636454668" class="form-control" placeholder="How many hours a day will this dog be left alone?" max="24" step="1" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1786636259419">Where will the dog be left when you are not home?  Where will the dog spend most of the day?   Where will the dog spend the night?</label><span>*</span><textarea  name="textarea-1786636259419" placeholder="Where will the dog be left when you are not home?  Where will the dog spend most of the day?   Where will the dog spend the night?" class="form-control" rows="3" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1786636259561">What is your ideal dog and why? (Please list dog name here if you are applying for a specific dog).</label><span>*</span><textarea  name="textarea-1786636259561" placeholder="What is your ideal dog and why? (Please list dog name here if you are applying for a specific dog)." class="form-control" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1786636259703">Desired age/size/breed</label><span>*</span><textarea  name="textarea-1786636259703" placeholder="Desired age/size/breed" class="form-control" rows="2" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="checkbox-group"><div class="form-group"><label for="checkbox-group-1786636577845">Willing to adopt</label><div class=""><label for="checkbox-group-1786636577845-0" class="checkbox-label"><input type="checkbox" id="checkbox-group-1786636577845-0" value="Outgoing/hyper dog" name="checkbox-group-1786636577845[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Outgoing/hyper dog</span></label><br><label for="checkbox-group-1786636577845-1" class="checkbox-label"><input type="checkbox" id="checkbox-group-1786636577845-1" value="Shy dog" name="checkbox-group-1786636577845[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Shy dog</span></label><br><label for="checkbox-group-1786636577845-2" class="checkbox-label"><input type="checkbox" id="checkbox-group-1786636577845-2" value="Dog that needs regular medication " name="checkbox-group-1786636577845[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Dog that needs regular medication </span></label><br><label for="checkbox-group-1786636577845-3" class="checkbox-label"><input type="checkbox" id="checkbox-group-1786636577845-3" value="Dog that needs training" name="checkbox-group-1786636577845[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Dog that needs training</span></label><br><label for="checkbox-group-1786636577845-4" class="checkbox-label"><input type="checkbox" id="checkbox-group-1786636577845-4" value="Dog that needs grooming" name="checkbox-group-1786636577845[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Dog that needs grooming</span></label><br><label for="checkbox-group-1786636577845-5" class="checkbox-label"><input type="checkbox" id="checkbox-group-1786636577845-5" value="None of these" name="checkbox-group-1786636577845[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">None of these</span></label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1789606447189">Any breeds you will NOT adopt (enter &quot;NA&quot; if not applicable)</label><span>*</span><textarea  name="textarea-1789606447189" placeholder="Any breeds you will NOT adopt (enter &quot;NA&quot; if not applicable)" class="form-control" rows="4" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1789606541749">Desired Sex</label><div class=""><input type="radio" id="radio-group-1789606541749-0"  value="Male" name="radio-group-1789606541749[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789606541749-0" class="radio-label">Male</label><br><input type="radio" id="radio-group-1789606541749-1"  value="Female" name="radio-group-1789606541749[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789606541749-1" class="radio-label">Female</label><br><input type="radio" id="radio-group-1789606541749-2"  value="No Preference" name="radio-group-1789606541749[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1789606541749-2" class="radio-label">No Preference</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1789606639629">Do you have someone that can take care of the dog if you are no longer able to?</label><span>*</span><textarea  name="textarea-1789606639629" placeholder="Do you have someone that can take care of the dog if you are no longer able to?" class="form-control" rows="3" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1789606723892">What do you think the average monthly cost of a dog is?</label><span>*</span><textarea  name="textarea-1789606723892" placeholder="What do you think the average monthly cost of a dog is?" class="form-control" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1786636701246">Do you agree to keep the dog as an indoor dog?</label><div class=""><input type="radio" id="radio-group-1786636701246-0"  value="Yes" name="radio-group-1786636701246[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636701246-0" class="radio-label">Yes</label><br><input type="radio" id="radio-group-1786636701246-1"  value="No" name="radio-group-1786636701246[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636701246-1" class="radio-label">No</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1786636722131">Are you willing to let a member of Dauntless animal and Wildlife Rescue do a home visit?</label><div class=""><input type="radio" id="radio-group-1786636722131-0"  value="Yes" name="radio-group-1786636722131[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636722131-0" class="radio-label">Yes</label><br><input type="radio" id="radio-group-1786636722131-1"  value="No" name="radio-group-1786636722131[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636722131-1" class="radio-label">No</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1786636700714">Do you agree to contact Dauntless animal and Wildlife Rescue if you cannot keep this dog?</label><div class=""><input type="radio" id="radio-group-1786636700714-0"  value="Yes" name="radio-group-1786636700714[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636700714-0" class="radio-label">Yes</label><br><input type="radio" id="radio-group-1786636700714-1"  value="No" name="radio-group-1786636700714[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636700714-1" class="radio-label">No</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="radio-group"><div class="form-group"><label for="radio-group-1786636658450">Do you agree to provide regular healthcare by a licensed veterinarian?</label><div class=""><input type="radio" id="radio-group-1786636658450-0"  value="Yes" name="radio-group-1786636658450[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636658450-0" class="radio-label">Yes</label><br><input type="radio" id="radio-group-1786636658450-1"  value="No" name="radio-group-1786636658450[]" class="" required data-msg-required="This field is required.">&nbsp;<label for="radio-group-1786636658450-1" class="radio-label">No</label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="file"><div class="form-group"><label for="file-1789606811464">Please attach a photo of your yard, or area your dog plans to use outside</label><span>*</span><input type="file"  name="file-1789606811464" placeholder="Please attach a photo of your yard, or area your dog plans to use outside" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="file"><div class="form-group"><label for="file-1789606838830">Please attach a photo of the area you plan to keep the dog inside your home</label><span>*</span><input type="file"  name="file-1789606838830" placeholder="Please attach a photo of the area you plan to keep the dog inside your home" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1786636760524">Please provide two references, their name, phone number and email address and relationship to you</label><span>*</span><textarea  name="textarea-1786636760524" placeholder="Please provide two references, their name, phone number and email address and relationship to you" class="form-control" rows="5" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="checkbox-group"><div class="form-group"><label for="checkbox-group-1789607587903">All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.</label><div class=""><label for="checkbox-group-1789607587903-0" class="checkbox-label"><input type="checkbox" id="checkbox-group-1789607587903-0" value="I Agree" name="checkbox-group-1789607587903[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">I Agree</span></label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1789607741320">By signing your name below you verify that all the information stated above is true. 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