Pet Rescue - Application
Note: This information is only used to refine adoption matches.
Please provide the following confidential information:
Contact Name:		* Required
Note: A pet may react adversly to a particular person, at first, and may take an unforseen protective stance against someone. For example, a dog owned by a woman may react adversly towards strange men. Providing your gender enables the A/I Neural Network to disintermediate applicants to achive optimal matches. [Strictly Confidential]
Contact Gender:	Select...MaleFemaleLGBTQPrivateNo Answer[Confidential Information]	* Helpful
Pet`s Name:		* Required
Type/Kind:	Select...DogCatSomething else...	* Required
Dog Breed:	Select...MixedUnknownAffenpinscherAfghan HoundAiredale TerrierAkitaAlaskan MalamuteAmerican BulldogAmerican Eskimo DogAmerican FoxhoundAmerican Pit Bull TerrierAmerican Staffordshire TerrierAnatolian ShepherdAussiedoodleAustralian Cattle DogAustralian KelpieAustralian ShepherdAustralian TerrierBarbetBasenjiBasset HoundBeagleBearded CollieBeauceronBedlington TerrierBelgian MalinoisBelgian Sheepdog (Groenendael)BernedoodleBernese Mountain DogBichon FriseBiewer TerrierBloodhoundBluetick CoonhoundBoerboelBologneseBorder CollieBorder TerrierBorzoiBoston TerrierBouvier des FlandresBoxerBoykin SpanielBriardBrittanyBrussels GriffonBull TerrierBulldog (English Bulldog)BullmastiffCairn TerrierCane CorsoCardigan Welsh CorgiCarolina DogCatahoula Leopard DogCavalier King Charles SpanielCavapooChesapeake Bay RetrieverChihuahuaChinese CrestedChinese Shar-PeiChinookChiweenieChorkieChow ChowChug DogClumber SpanielCockapooCocker SpanielCollieCoton de TulearDachshundDalmatianDoberman PinscherDogo ArgentinoDogue de BordeauxDutch ShepherdEnglish Cocker SpanielEnglish SetterEnglish Springer SpanielEntlebucher Mountain DogFlat-Coated RetrieverFrench BulldogGerman PinscherGerman ShepherdGerman Shorthaired PointerGerman Wirehaired PointerGiant SchnauzerGolden RetrieverGoldendoodleGordon SetterGreat DaneGreat PyreneesGreater Swiss Mountain DogGreyhoundHarrierHavaneseIrish SetterIrish TerrierIrish Water SpanielIrish WolfhoundItalian GreyhoundJack Russell TerrierJapanese ChinKeeshondKerry Blue TerrierKomondorKuvaszLabradoodleLabrador RetrieverLagotto RomagnoloLakeland TerrierLancashire HeelerLeonbergerLhasa ApsoMalteseMaltipooManchester TerrierMastiffMiniature American ShepherdMiniature PinscherMiniature PoodleMiniature SchnauzerMorkieNeapolitan MastiffNederlandse KooikerhondjeNewfoundlandNorfolk TerrierNorwegian ElkhoundNorwich TerrierNova Scotia Duck Tolling RetrieverOld English SheepdogPapillonPekingesePembroke Welsh CorgiPharaoh HoundPlott HoundPointerPomeranianPomskyPortuguese Water DogPugPugglePuliPumiRat TerrierRedbone CoonhoundRhodesian RidgebackRottweilerRussell TerrierSaint BernardSalukiSamoyedSchipperkeScottish TerrierSheepadoodleShetland SheepdogShiba InuShih TzuSiberian HuskySilken WindhoundSilky TerrierSmooth Fox TerrierSpanish Water DogStaffordshire Bull TerrierStandard PoodleStandard SchnauzerSwedish VallhundTibetan MastiffTibetan SpanielTibetan TerrierToy PoodleTreeing Walker CoonhoundVizslaWeimaranerWelsh Springer SpanielWelsh TerrierWest Highland White TerrierWhippetXoloitzcuintliYorkshire TerrierSomething else...
Cat Breed:	Select...MixedUnknownAbyssinianAmerican BobtailAmerican Bobtail ShorthairAmerican CurlAmerican ShorthairAmerican WirehairAustralian MistBalineseBengalBirmanBombayBritish LonghairBritish ShorthairBurmeseBurmillaChartreuxChausieCherubimCornish RexCymricDevon RexDonskoyEgyptian MauExotic ShorthairHavanaHighlanderHimalayanJapanese BobtailKhaomaneeKoratKurilian BobtailLaPermLykoiMaine CoonManxMinuetMunchkinNebelungNorwegian ForestOcicatOriental LonghairOriental ShorthairPersianPeterbaldPixiebobRagdollRussian BlueSavannahScottish FoldScottish StraightSelkirk RexSiameseSiberianSingapuraSnowshoeSomaliSphynxTennessee RexThaiTonkineseToygerTurkish AngoraTurkish VanSomething else...
Pet`s Gender:	Select...Male-NeuteredFemale-SpayedMale-IntactFemale-Intact	* Required
Size:	Select...SmallMediumLarge	* Required
Colorings:	Select...MixedWhiteBlackGreyEnter...
Age:	Select...UknownNewborn1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10+ YearsSomething else...	* Helpful
If there is a particular date upon which a celebratory event occurs please provide the date and describe the occation in the notes.
Anniversary:
If the pet has an Identification Microchip implanted please provide the Microchip Reference Number and the name of the registration organization in the notes.
Microchip Number:
Relation/Sevice:	Select...CompanionGuideGuardTherapyHuntingSomething else...
Friendliness:	Select...ChildAdolescenceAdultElderSomething else...
Training:	Select...HomeProfessionalObedienceK9Something else...
Behavior:	Select...PlayfulAffectionateCalmActiveN/A	*
Indicate if the pet currently lives with other companion pets. Please enter any additional information in the notes.
Pet`s Companions:	Select...YesNo	* Helpful
Likes:	Select...WalksDog ParksCar RidesBeachN/ASee Notations...	*
Dislikes:	Select...StrangersFireworksCar Rides (Nausea)N/ASee Notations...	*
Medical Issues:	Select...NoneMedication RequiredSomething else...	*
Special Needs:	Select...NoneProthesis CareHygenic CareSomething else...	*
Biting Issues:	Select...NonePlayfulCautionSomething else...	*
Barking:	Select...MinimalVocalVerboseSomething else...	*
Toys:	Select...TransferPurchaseNot a concern	*
Pets are placed for adoption for a variety of reasons. Concider your preference regarding these situations.
Adoption Reason:	Select...AbandonedRescuedAffordabilityRelocatingLease RestrictionsWidowedSee Notes	*
A pet may already be accostomed to a particular habitat and sleeping conditions. For example, a pet may be accostomed to sleeping in the owner`s bed, whereas, the new owner may not be amenable to this arrangement. This enables the A/I Neural Network to disintermediate these accomodations to achive optimal matches.
Sleeping:	Select...Owner BedSeparate BedSeparate RoomCageSee Notations...Something else...	*
Fenced Yard:	Select...YesNoSomething else...	*
Electronic Fence:	Select...YesNoSomething else...	*
Housing:	Select...Domicile LivingOutdoor QuartersN/A	*
Please enter the brand of food the pet is currently being fed.
Feeding:		*
Last Vetinary Visit:		*
Vetinary Insurance:	Select...YesNoSomething else...	*
If the adoption is sponsored by an Animal Care Facility please provide the organization name for proper acredidation.
Provider Name:		*
Address Line 1:		*
Address Line 2:		*
City:		*
State:		*
Zip Code:		*
Office Phone:		*
Mobile Phone:		*
eMail Address:		*
If the provider is an Animal Care Facility or Shelter and requests a donation, or requires an adoption placement fee be paid, please specify this information.
Fee:	Select...NoneEnter Amount...	*
Messaging:	Select...eMaileMail & TextService Call	*
Please feel free to tell the story of this pet and leave any other notations...
Notations:		*
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