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<channel>
	<title>Cozumel Humane SocietyCozumel Humane Society - Give us a hand.</title>
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	<link>http://www.humanecozumel.org</link>
	<description>Give us a hand.</description>
	<lastBuildDate>Thu, 09 May 2013 04:35:10 +0000</lastBuildDate>
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		<item>
		<title>Kimberly</title>
		<link>http://www.humanecozumel.org/kimberly/</link>
		<comments>http://www.humanecozumel.org/kimberly/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:35:10 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=4021</guid>
		<description><![CDATA[<p>Kimberly, approximately 7 months old, female. Weight 9.1 kg. She was found about two months ago and taken in by her rescuers, but their landlord said she goes or you go, so sadly she is now at a shelter! She is a beautiful dog with lovely markings! She misses her rescuers. Admission date April 27th, <p><a class="more-link" href="http://www.humanecozumel.org/kimberly/"><span>Read more</span></a></p></p><p>The post <a href="http://www.humanecozumel.org/kimberly/">Kimberly</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Kimberly, approximately 7 months old, female. Weight 9.1 kg. She was found about two months ago and taken in by her rescuers, but their landlord said she goes or you go, so sadly she is now at a shelter! She is a beautiful dog with lovely markings! She misses her rescuers. Admission date April 27th, 2013</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/KIMBERLY.jpg"><img class="alignnone size-full wp-image-4022" alt="KIMBERLY" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/KIMBERLY.jpg" width="636" height="960" /></a></p>

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                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
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            <h3 class='gf_progressbar_title'>Step 1 of 3
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                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
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                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Name</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/kimberly/">Kimberly</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
			<wfw:commentRss>http://www.humanecozumel.org/kimberly/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
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		<item>
		<title>Luis</title>
		<link>http://www.humanecozumel.org/luis-2/</link>
		<comments>http://www.humanecozumel.org/luis-2/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:33:25 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=4018</guid>
		<description><![CDATA[<p>Luis is a handsome dog approximately 1 and 1/2 years old. He was taken along with the 9 puppies from the transversal area by animal control. He could be the father to some of these puppies. Luis has an excellent personality, very loving. He is positive for heart worm and he has already received his <p><a class="more-link" href="http://www.humanecozumel.org/luis-2/"><span>Read more</span></a></p></p><p>The post <a href="http://www.humanecozumel.org/luis-2/">Luis</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Luis is a handsome dog approximately 1 and 1/2 years old. He was taken along with the 9 puppies from the transversal area by animal control. He could be the father to some of these puppies. Luis has an excellent personality, very loving. He is positive for heart worm and he has already received his first two treatments, but could use some sponsorship for his final treatment, which is due in 3 weeks. Admission date April 18th, 2013</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/LUIS.jpg"><img class="alignnone size-full wp-image-4019" alt="LUIS" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/LUIS.jpg" width="954" height="960" /></a></p>

                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' name='gf_1' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/feed/#gf_1'>
                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
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            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
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                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Phone</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/luis-2/">Luis</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
			<wfw:commentRss>http://www.humanecozumel.org/luis-2/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
		</item>
		<item>
		<title>Luna</title>
		<link>http://www.humanecozumel.org/luna/</link>
		<comments>http://www.humanecozumel.org/luna/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:31:38 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=4015</guid>
		<description><![CDATA[<p>Luna is female 8 months old, weight 10.4 kg. She was abandoned before operating hours tied by a rope to a tree outside of the Humane Society. Her owners definitely abandoned her.  She is just so sad as she goes through quarantine. We are so hopeful she will find a great new loving home soon! <p><a class="more-link" href="http://www.humanecozumel.org/luna/"><span>Read more</span></a></p></p><p>The post <a href="http://www.humanecozumel.org/luna/">Luna</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Luna is female 8 months old, weight 10.4 kg. She was abandoned before operating hours tied by a rope to a tree outside of the Humane Society. Her owners definitely abandoned her.  She is just so sad as she goes through quarantine. We are so hopeful she will find a great new loving home soon! Admission date: April 28th, 2013</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/LUNA2.jpg"><img class="alignnone size-full wp-image-4016" alt="LUNA2" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/LUNA2.jpg" width="636" height="960" /></a></p>

                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' name='gf_1' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/feed/#gf_1'>
                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
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            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
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                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Phone</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/luna/">Luna</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
			<wfw:commentRss>http://www.humanecozumel.org/luna/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
		</item>
		<item>
		<title>Miranda</title>
		<link>http://www.humanecozumel.org/miranda/</link>
		<comments>http://www.humanecozumel.org/miranda/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:29:14 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=4012</guid>
		<description><![CDATA[<p>Miranda is female, 1.5 years old. Weight 13 kg. She was found lost and wandering on 11 and Ave 50. The rescuers asked everybody in the area if they knew her and all said &#8220;no&#8221;. Very beautiful terrier mix!</p><p>The post <a href="http://www.humanecozumel.org/miranda/">Miranda</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Miranda is female, 1.5 years old. Weight 13 kg. She was found lost and wandering on 11 and Ave 50. The rescuers asked everybody in the area if they knew her and all said &#8220;no&#8221;. Very beautiful terrier mix!</span></span><span class="fbPhotoTagList" id="fbPhotoSnowliftTagList"></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/MIRANDA.jpg"><img class="alignnone size-full wp-image-4013" alt="MIRANDA" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/MIRANDA.jpg" width="960" height="636" /></a></p>

                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' name='gf_1' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/feed/#gf_1'>
                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
        </h3>
            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
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                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Name</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/miranda/">Miranda</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
			<wfw:commentRss>http://www.humanecozumel.org/miranda/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
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		<item>
		<title>Sol</title>
		<link>http://www.humanecozumel.org/sol/</link>
		<comments>http://www.humanecozumel.org/sol/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:27:15 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=4009</guid>
		<description><![CDATA[<p>Sol, female 2 year old Chihuahua. Weight 2 kg. She is another example WHY people should think twice about breeding and selling them! Her owner went on vacation and left her with a friend, who has two big dogs that almost tried to kill her. When the owner was contacted she told her friend, &#8220;just <p><a class="more-link" href="http://www.humanecozumel.org/sol/"><span>Read more</span></a></p></p><p>The post <a href="http://www.humanecozumel.org/sol/">Sol</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Sol, female 2 year old Chihuahua. Weight 2 kg. She is another example WHY people should think twice about breeding and selling them! Her owner went on vacation and left her with a friend, who has two big dogs that almost tried to kill her. When the owner was contacted she told her friend, &#8220;just give her away&#8221;. Chihuahuas do not do well at our shelter, they are two small to mix with our pack and are often terrified. We are looking for an immediate adoption and or foster placement. Admission date: April 28th, 2013</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/SOL.jpg"><img class="alignnone size-full wp-image-4010" alt="SOL" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/SOL.jpg" width="827" height="960" /></a></p>

                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' name='gf_1' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/feed/#gf_1'>
                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
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            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
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                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Email</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/sol/">Sol</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
			<wfw:commentRss>http://www.humanecozumel.org/sol/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
		</item>
		<item>
		<title>Star</title>
		<link>http://www.humanecozumel.org/star/</link>
		<comments>http://www.humanecozumel.org/star/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:22:03 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=4006</guid>
		<description><![CDATA[<p>Star, female 2 years old. Weight 9.4 kg. She was reported by the Iberostar Hotel. Unfortunately it is not uncommon for people to dump their dogs in this area, not the first dog we have had from Iberostar. Although they maintain a great Cat Cafe program, stray dogs are not part of the program. She <p><a class="more-link" href="http://www.humanecozumel.org/star/"><span>Read more</span></a></p></p><p>The post <a href="http://www.humanecozumel.org/star/">Star</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Star, female 2 years old. Weight 9.4 kg. She was reported by the Iberostar Hotel. Unfortunately it is not uncommon for people to dump their dogs in this area, not the first dog we have had from Iberostar. Although they maintain a great Cat Cafe program, stray dogs are not part of the program. She was well fed by tourist and staff alike but she had to go and is now with us. Admission date April 28th, 2013</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/STAR.jpg"><img class="alignnone size-full wp-image-4007" alt="STAR" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/STAR.jpg" width="907" height="960" /></a></p>

                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' name='gf_1' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/feed/#gf_1'>
                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
        </h3>
            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
            </div></div>
                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Phone</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/star/">Star</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
			<wfw:commentRss>http://www.humanecozumel.org/star/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
		</item>
		<item>
		<title>Cherokee</title>
		<link>http://www.humanecozumel.org/cherokee/</link>
		<comments>http://www.humanecozumel.org/cherokee/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:19:42 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=4003</guid>
		<description><![CDATA[<p>Cherokee, 3 month old male, current weight 3.9 kg.  Found scared and cowering under a van. Nobody in the neighborhood knew who he was and now he is at the HSCI. Adorable puppy, very sweet. Admission date: May 4th, 2013</p><p>The post <a href="http://www.humanecozumel.org/cherokee/">Cherokee</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Cherokee, 3 month old male, current weight 3.9 kg.  Found scared and cowering under a van. Nobody in the neighborhood knew who he was and now he is at the HSCI. Adorable puppy, very sweet. Admission date: May 4th, 2013</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/CHEROKEE2.jpg"><img class="alignnone size-full wp-image-4004" alt="CHEROKEE2" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/CHEROKEE2.jpg" width="900" height="891" /></a></p>

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                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
        </h3>
            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
            </div></div>
                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Comments</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/cherokee/">Cherokee</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
			<wfw:commentRss>http://www.humanecozumel.org/cherokee/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
		</item>
		<item>
		<title>Erzo</title>
		<link>http://www.humanecozumel.org/erzo/</link>
		<comments>http://www.humanecozumel.org/erzo/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:17:16 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=4000</guid>
		<description><![CDATA[<p>Erzo, male 1 and 1/2 years old, weight 13.7 kg. He was found at the passenger ferry that leaves Cozumel to Playa Del Carmen. HSCI was contacted and staff was sent to pick him up. He had a black collar on and no ID tags. Very handsome sociable dog and definitely has an owner, but <p><a class="more-link" href="http://www.humanecozumel.org/erzo/"><span>Read more</span></a></p></p><p>The post <a href="http://www.humanecozumel.org/erzo/">Erzo</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Erzo, male 1 and 1/2 years old, weight 13.7 kg. He was found at the passenger ferry that leaves Cozumel to Playa Del Carmen. HSCI was contacted and staff was sent to pick him up. He had a black collar on and no ID tags. Very handsome sociable dog and definitely has an owner, but nobody has come to look for him yet. Admission date May 4th, 2103</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/ERZO.jpg"><img class="alignnone size-full wp-image-4001" alt="ERZO" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/ERZO.jpg" width="636" height="960" /></a></p>

                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' name='gf_1' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/feed/#gf_1'>
                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
        </h3>
            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
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                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Name</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/erzo/">Erzo</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
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		<item>
		<title>Fifi</title>
		<link>http://www.humanecozumel.org/fifi/</link>
		<comments>http://www.humanecozumel.org/fifi/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:15:53 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=3997</guid>
		<description><![CDATA[<p>Fifi is female, 3 years old, weight 4.6 kg. She was completely infested with ticks and left abandoned in a common rental property. Animal Control was called to take her away and she has since been transferred to the HSCI. She is now tick free and is a very loving sweet dog that deserves a <p><a class="more-link" href="http://www.humanecozumel.org/fifi/"><span>Read more</span></a></p></p><p>The post <a href="http://www.humanecozumel.org/fifi/">Fifi</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Fifi is female, 3 years old, weight 4.6 kg. She was completely infested with ticks and left abandoned in a common rental property. Animal Control was called to take her away and she has since been transferred to the HSCI. She is now tick free and is a very loving sweet dog that deserves a second chance! Admission date May 2, 2013</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/FIFI2.jpg"><img class="alignnone size-full wp-image-3998" alt="FIFI2" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/FIFI2.jpg" width="960" height="844" /></a></p>

                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' name='gf_1' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/feed/#gf_1'>
                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
        </h3>
            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
            </div></div>
                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Comments</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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<p>The post <a href="http://www.humanecozumel.org/fifi/">Fifi</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></content:encoded>
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		<item>
		<title>Lluvia</title>
		<link>http://www.humanecozumel.org/lluvia/</link>
		<comments>http://www.humanecozumel.org/lluvia/#comments</comments>
		<pubDate>Thu, 09 May 2013 04:13:48 +0000</pubDate>
		<dc:creator>Anne</dc:creator>
				<category><![CDATA[Dogs]]></category>

		<guid isPermaLink="false">http://www.humanecozumel.org/?p=3994</guid>
		<description><![CDATA[<p>Lluvia (rain in Spanish) female approx 5 months old. Current weight 8 kg. She was found in the pouring rain by her rescuers and her photos were posted on Facebook. Her owners saw these post, but when they learned they would have to pay an adoption fee that does not even cover the cost of <p><a class="more-link" href="http://www.humanecozumel.org/lluvia/"><span>Read more</span></a></p></p><p>The post <a href="http://www.humanecozumel.org/lluvia/">Lluvia</a> appeared first on <a href="http://www.humanecozumel.org">Cozumel Humane Society</a>.</p>]]></description>
				<content:encoded><![CDATA[<p><span class="fbPhotosPhotoCaption" id="fbPhotoSnowliftCaption" tabindex="0" data-ft="{&quot;type&quot;:45}"><span class="hasCaption">Lluvia (rain in Spanish) female approx 5 months old. Current weight 8 kg. She was found in the pouring rain by her rescuers and her photos were posted on Facebook. Her owners saw these post, but when they learned they would have to pay an adoption fee that does not even cover the cost of the vaccines, heart worm testing and spay procedure they decided to leave her there refusing to pay. She is mostly golden Labrador. She is a beautiful puppy and would make a great family pet! Admission date: May 2, 2013</span></span></p>
<p><a href="http://www.humanecozumel.org/wp-content/uploads/2013/05/LLUVIA.jpg"><img class="alignnone size-full wp-image-3995" alt="LLUVIA" src="http://www.humanecozumel.org/wp-content/uploads/2013/05/LLUVIA.jpg" width="960" height="816" /></a></p>

                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' name='gf_1' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/feed/#gf_1'>
                        <div class='gform_heading'>
                            <h3 class='gform_title'>Humane Society of Cozumel Dog Adoption Form</h3>
                            <span class='gform_description'>All potential adopters are screened for suitable placement.  HSCI may refuse placement of an animal for any reason.   
<p></p>
By submitting this application you give permission for HSCI to verify the information you provide.  All forms become the property of HSCI upon submission. 
<p></p>
I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to HSCI.</span>
                        </div>
        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>
            <h3 class='gf_progressbar_title'>Step 1 of 3
        </h3>
            <div class='gf_progressbar'>
                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%</span></div>
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                        <div class='gform_body'><div id='gform_page_1_1' class='gform_page' >
                                    <div class='gform_page_fields'>
                            <ul id='gform_fields_1' class='gform_fields top_label description_below'><li id='field_1_18' class='gfield  gsection' ><h2 class='gsection_title'>Animal Information</h2></li><li id='field_1_1' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_1'>Name of the dog I am applying for:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_1' id='input_1_1' type='text' value='' class='medium'  tabindex='1'   /></div></li><li id='field_1_24' class='gfield  gsection' ><h2 class='gsection_title'>Vetrinarians Information</h2></li><li id='field_1_5' class='gfield    gf_list_5col           gfield_contains_required' ><label class='gfield_label'>I currently have a family veterinarian<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_5'><li class='gchoice_5_0'><input name='input_5' type='radio' value='Yes'  id='choice_5_0' tabindex='2'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_0'>Yes</label></li><li class='gchoice_5_1'><input name='input_5' type='radio' value='No'  id='choice_5_1' tabindex='3'  onclick='gf_apply_rules(1,[22,12,13]);'  /><label for='choice_5_1'>No</label></li></ul></div></li><li id='field_1_22' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_22'>My current veterinarians name:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_22' id='input_1_22' type='text' value='' class='medium' tabindex='4' /></div></li><li id='field_1_12' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_12_1'>My current veterinarian can be contacted at:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_12'><span class='ginput_full' id='input_1_12_1_container'><input type='text' name='input_12.1' id='input_1_12_1' value='' tabindex='5' /><label for='input_1_12_1' id='input_1_12_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_12_3_container'><input type='text' name='input_12.3' id='input_1_12_3' value='' tabindex='6' /><label for='input_1_12_3' id='input_1_12.3_label'>City</label></span><span class='ginput_right' id='input_1_12_4_container' ><input type='text' name='input_12.4' id='input_1_12_4' value='' tabindex='8'   /><label for='input_1_12_4' id='input_1_12_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_12_5_container'><input type='text' name='input_12.5' id='input_1_12_5' value='' tabindex='9' /><label for='input_1_12_5' id='input_1_12_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_12_6_container' ><select name='input_12.6' id='input_1_12_6' tabindex='10' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_12_6' id='input_1_12_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_13' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_13'>My current veterinarians telephone number:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_13' id='input_1_13' type='tel' value='' class='medium' tabindex='11'  /></div></li><li id='field_1_14' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Information</h2></li><li id='field_1_10' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_10_3'>Adopters Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_10'><span id='input_1_10_3_container' class='ginput_left'><input type='text' name='input_10.3' id='input_1_10_3' value='' tabindex='12' /><label for='input_1_10_3'>First</label></span><span id='input_1_10_6_container' class='ginput_right'><input type='text' name='input_10.6' id='input_1_10_6' value='' tabindex='13' /><label for='input_1_10_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_81' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_81'>Date of Birth<span class='gfield_required'>*</span></label><div class='clear-multi'><div class='gfield_date_month ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_1' value='' tabindex='14' /><label for='input_1_81_1'>MM</label></div><div class='gfield_date_day ginput_container' id='input_1_81'><input type='text' maxlength='2' name='input_81[]' id='input_1_81_2' value='' tabindex='15' /><label for='input_1_81_2'>DD</label></div><div class='gfield_date_year ginput_container' id='input_1_81'><input type='text' maxlength='4' name='input_81[]' id='input_1_81_3' value='' tabindex='16' /><label for='input_1_81_3'>YYYY</label></div></div></li><li id='field_1_11' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_11_1'>Adopters Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_11'><span class='ginput_full' id='input_1_11_1_container'><input type='text' name='input_11.1' id='input_1_11_1' value='' tabindex='17' /><label for='input_1_11_1' id='input_1_11_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_11_3_container'><input type='text' name='input_11.3' id='input_1_11_3' value='' tabindex='18' /><label for='input_1_11_3' id='input_1_11.3_label'>City</label></span><span class='ginput_right' id='input_1_11_4_container' ><input type='text' name='input_11.4' id='input_1_11_4' value='' tabindex='20'   /><label for='input_1_11_4' id='input_1_11_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_11_5_container'><input type='text' name='input_11.5' id='input_1_11_5' value='' tabindex='21' /><label for='input_1_11_5' id='input_1_11_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_11_6_container' ><select name='input_11.6' id='input_1_11_6' tabindex='22' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_11_6' id='input_1_11_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_80' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_80'>Adopters Email Address<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_80' id='input_1_80' type='email' value='' class='medium'  tabindex='23'   /></div></li><li id='field_1_15' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_15'>Adopters Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_15' id='input_1_15' type='tel' value='' class='medium' tabindex='24'  /></div></li><li id='field_1_16' class='gfield' ><label class='gfield_label' for='input_1_16_3'>Spouse/Partners Name:</label><div class='ginput_complex ginput_container' id='input_1_16'><span id='input_1_16_3_container' class='ginput_left'><input type='text' name='input_16.3' id='input_1_16_3' value='' tabindex='25' /><label for='input_1_16_3'>First</label></span><span id='input_1_16_6_container' class='ginput_right'><input type='text' name='input_16.6' id='input_1_16_6' value='' tabindex='26' /><label for='input_1_16_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_17' class='gfield' ><label class='gfield_label' for='input_1_17'>Spouse/Partners Phone:</label><div class='ginput_container'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='27'  /></div></li><li id='field_1_82' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Employment Information</h2></li><li id='field_1_84' class='gfield               gfield_contains_required' ><label class='gfield_label'>Are you Currently Employed <span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_84'><li class='gchoice_84_0'><input name='input_84' type='radio' value='Yes'  id='choice_84_0' tabindex='28'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_0'>Yes</label></li><li class='gchoice_84_1'><input name='input_84' type='radio' value='No'  id='choice_84_1' tabindex='29'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_1'>No</label></li><li class='gchoice_84_2'><input name='input_84' type='radio' value='Retired'  id='choice_84_2' tabindex='30'  onclick='gf_apply_rules(1,[85]);'  /><label for='choice_84_2'>Retired</label></li></ul></div></li><li id='field_1_85' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_85'>Occupation and/or Name of your current employer<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_85' id='input_1_85' class='textarea medium' tabindex='31'   rows='10' cols='50'></textarea></div></li><li id='field_1_23' class='gfield  gsection' ><h2 class='gsection_title'>Adopters Personal Reference</h2></li><li id='field_1_20' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_20_3'>Personal Reference Name:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_20'><span id='input_1_20_3_container' class='ginput_left'><input type='text' name='input_20.3' id='input_1_20_3' value='' tabindex='32' /><label for='input_1_20_3'>First</label></span><span id='input_1_20_6_container' class='ginput_right'><input type='text' name='input_20.6' id='input_1_20_6' value='' tabindex='33' /><label for='input_1_20_6'>Last</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_19' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_19_1'>Personal Reference Address:<span class='gfield_required'>*</span></label><div class='ginput_complex ginput_container' id='input_1_19'><span class='ginput_full' id='input_1_19_1_container'><input type='text' name='input_19.1' id='input_1_19_1' value='' tabindex='34' /><label for='input_1_19_1' id='input_1_19_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_19_3_container'><input type='text' name='input_19.3' id='input_1_19_3' value='' tabindex='35' /><label for='input_1_19_3' id='input_1_19.3_label'>City</label></span><span class='ginput_right' id='input_1_19_4_container' ><input type='text' name='input_19.4' id='input_1_19_4' value='' tabindex='37'   /><label for='input_1_19_4' id='input_1_19_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_19_5_container'><input type='text' name='input_19.5' id='input_1_19_5' value='' tabindex='38' /><label for='input_1_19_5' id='input_1_19_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_19_6_container' ><select name='input_19.6' id='input_1_19_6' tabindex='39' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_19_6' id='input_1_19_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_21' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_21'>Personal Reference Phone:<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_21' id='input_1_21' type='tel' value='' class='medium' tabindex='40'  /></div></li><li id='field_1_25' class='gfield  gsection' ><h2 class='gsection_title'>Household Situation</h2></li><li id='field_1_28' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Which do you live in?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_28'><li class='gchoice_28_0'><input name='input_28' type='radio' value='House'  id='choice_28_0' tabindex='41'    /><label for='choice_28_0'>House</label></li><li class='gchoice_28_1'><input name='input_28' type='radio' value='Apartment'  id='choice_28_1' tabindex='42'    /><label for='choice_28_1'>Apartment</label></li><li class='gchoice_28_2'><input name='input_28' type='radio' value='Condominium'  id='choice_28_2' tabindex='43'    /><label for='choice_28_2'>Condominium</label></li><li class='gchoice_28_3'><input name='input_28' type='radio' value='Townhouse'  id='choice_28_3' tabindex='44'    /><label for='choice_28_3'>Townhouse</label></li></ul></div></li><li id='field_1_31' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you rent or own?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_31'><li class='gchoice_31_0'><input name='input_31' type='radio' value='Rent'  id='choice_31_0' tabindex='45'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_0'>Rent</label></li><li class='gchoice_31_1'><input name='input_31' type='radio' value='Own'  id='choice_31_1' tabindex='46'  onclick='gf_apply_rules(1,[32]);'  /><label for='choice_31_1'>Own</label></li></ul></div></li><li id='field_1_32' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Does your landlord allow pets?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_32'><li class='gchoice_32_0'><input name='input_32' type='radio' value='Yes'  id='choice_32_0' tabindex='47'    /><label for='choice_32_0'>Yes</label></li><li class='gchoice_32_1'><input name='input_32' type='radio' value='No'  id='choice_32_1' tabindex='48'    /><label for='choice_32_1'>No</label></li></ul></div></li><li id='field_1_29' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do you have a fenced yard?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_29'><li class='gchoice_29_0'><input name='input_29' type='radio' value='Yes'  id='choice_29_0' tabindex='49'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_0'>Yes</label></li><li class='gchoice_29_1'><input name='input_29' type='radio' value='No'  id='choice_29_1' tabindex='50'  onclick='gf_apply_rules(1,[30]);'  /><label for='choice_29_1'>No</label></li></ul></div></li><li id='field_1_30' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_30'>What is the fence height?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_30' id='input_1_30'  class='medium gfield_select' tabindex='51' ><option value='select one that applies' >select one that applies</option><option value='3 feet' >3 feet</option><option value='4 feet' >4 feet</option><option value='5 feet' >5 feet</option><option value='6 feet or higher' >6 feet or higher</option></select></div></li><li id='field_1_33' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_33'>Number of adults in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_33' id='input_1_33'  class='medium gfield_select' tabindex='52' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option></select></div></li><li id='field_1_35' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_35'>Number of children in household:<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_35' id='input_1_35' onchange='gf_apply_rules(1,[36,37,40,39,38]);' class='medium gfield_select' tabindex='53' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option></select></div></li><li id='field_1_36' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_36'>Age of child 1<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_36' id='input_1_36'  class='medium gfield_select' tabindex='54' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_37' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_37'>Age of child 2<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_37' id='input_1_37'  class='medium gfield_select' tabindex='55' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_40' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_40'>Age of child 3<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_40' id='input_1_40'  class='medium gfield_select' tabindex='56' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_39' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_39'>Age of child 4<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_39' id='input_1_39'  class='medium gfield_select' tabindex='57' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_38' class='gfield          gfield_price gfield_price_1_ gfield_quantity_1_     gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_38'>Age of child 5<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_38' id='input_1_38'  class='medium gfield_select' tabindex='58' ><option value='select one that applies' >select one that applies</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option></select></div></li><li id='field_1_41' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Do all of the adults in the household consent to the adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_41'><li class='gchoice_41_0'><input name='input_41' type='radio' value='Yes'  id='choice_41_0' tabindex='59'    /><label for='choice_41_0'>Yes</label></li><li class='gchoice_41_1'><input name='input_41' type='radio' value='No'  id='choice_41_1' tabindex='60'    /><label for='choice_41_1'>No</label></li></ul></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                         <input type='button' id='gform_next_button_1_42' class='button gform_next_button' value='Next' tabindex='61' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_2' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_43' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership</h2></li><li id='field_1_44' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Where will this pet be kept?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_44'><li class='gchoice_44_0'><input name='input_44' type='radio' value='Mostly inside'  id='choice_44_0' tabindex='62'    /><label for='choice_44_0'>Mostly inside</label></li><li class='gchoice_44_1'><input name='input_44' type='radio' value='Totally inside'  id='choice_44_1' tabindex='63'    /><label for='choice_44_1'>Totally inside</label></li><li class='gchoice_44_2'><input name='input_44' type='radio' value='Mostly outside'  id='choice_44_2' tabindex='64'    /><label for='choice_44_2'>Mostly outside</label></li><li class='gchoice_44_3'><input name='input_44' type='radio' value='Totally outside'  id='choice_44_3' tabindex='65'    /><label for='choice_44_3'>Totally outside</label></li></ul></div></li><li id='field_1_45' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_45'>How long will this pet be left alone during the day?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_45' id='input_1_45'  class='medium gfield_select' tabindex='66' ><option value='select one that applies' >select one that applies</option><option value='none' >none</option><option value='1-3 hours' >1-3 hours</option><option value='3-6 hours' >3-6 hours</option><option value='6-9 hours' >6-9 hours</option><option value='9-11 hours' >9-11 hours</option><option value='12 or more hours' >12 or more hours</option></select></div></li><li id='field_1_46' class='gfield' ><label class='gfield_label' for='input_1_46'>where will the pet be kept while you are away at work?</label><div class='ginput_container'><textarea name='input_46' id='input_1_46' class='textarea medium' tabindex='67'   rows='10' cols='50'></textarea></div></li><li id='field_1_47' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to enroll the pet in obedience class if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_47'><li class='gchoice_47_0'><input name='input_47' type='radio' value='Yes'  id='choice_47_0' tabindex='68'    /><label for='choice_47_0'>Yes</label></li><li class='gchoice_47_1'><input name='input_47' type='radio' value='No'  id='choice_47_1' tabindex='69'    /><label for='choice_47_1'>No</label></li></ul></div></li><li id='field_1_48' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing or able to use a crate for the pet if needed or advised?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_48'><li class='gchoice_48_0'><input name='input_48' type='radio' value='Yes'  id='choice_48_0' tabindex='70'    /><label for='choice_48_0'>Yes</label></li><li class='gchoice_48_1'><input name='input_48' type='radio' value='No'  id='choice_48_1' tabindex='71'    /><label for='choice_48_1'>No</label></li></ul></div></li><li id='field_1_49' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are you willing to walk the pet if recommended?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_49'><li class='gchoice_49_0'><input name='input_49' type='radio' value='Yes'  id='choice_49_0' tabindex='72'    /><label for='choice_49_0'>Yes</label></li><li class='gchoice_49_1'><input name='input_49' type='radio' value='No'  id='choice_49_1' tabindex='73'    /><label for='choice_49_1'>No</label></li></ul></div></li><li id='field_1_50' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>You are adopting from a shelter, are you willing to work with the pet on house training?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_50'><li class='gchoice_50_0'><input name='input_50' type='radio' value='Yes'  id='choice_50_0' tabindex='74'    /><label for='choice_50_0'>Yes</label></li><li class='gchoice_50_1'><input name='input_50' type='radio' value='No'  id='choice_50_1' tabindex='75'    /><label for='choice_50_1'>No</label></li></ul></div></li><li id='field_1_51' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_51'>Where will the pet sleep at night?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_51' id='input_1_51' class='textarea medium' tabindex='76'   rows='10' cols='50'></textarea></div></li><li id='field_1_52' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_52'>Who are you getting this pet for?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_52' id='input_1_52' onchange='gf_apply_rules(1,[53]);' class='medium gfield_select' tabindex='77' ><option value='select one that applies' >select one that applies</option><option value='Self' >Self</option><option value='As a gift' >As a gift</option></select></div></li><li id='field_1_53' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_53'>Who is the pet a gift for?<span class='gfield_required'>*</span></label><div class='ginput_container'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='78'   /></div></li><li id='field_1_54' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_54'>What will you do with the pet if you have to move?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_54' id='input_1_54' class='textarea medium' tabindex='79'   rows='10' cols='50'></textarea></div></li><li id='field_1_55' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_55'>What will you do with the pet if you have to travel?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_55' id='input_1_55' class='textarea medium' tabindex='80'   rows='10' cols='50'></textarea></div></li><li id='field_1_56' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Does anyone have any concerns about adopting this pet?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_56'><li class='gchoice_56_0'><input name='input_56' type='radio' value='Yes'  id='choice_56_0' tabindex='81'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_0'>Yes</label></li><li class='gchoice_56_1'><input name='input_56' type='radio' value='No'  id='choice_56_1' tabindex='82'  onclick='gf_apply_rules(1,[57]);'  /><label for='choice_56_1'>No</label></li></ul></div></li><li id='field_1_57' class='gfield               gfield_contains_required' style='display:none;'><label class='gfield_label' for='input_1_57'>Who? And what are the concerns?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_57' id='input_1_57' class='textarea medium' tabindex='83'   rows='10' cols='50'></textarea></div></li><li id='field_1_58' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_58'>How much would you be willing to spend at the veterinarian in the case of an emergency?<span class='gfield_required'>*</span></label><div class='ginput_container'><select name='input_58' id='input_1_58'  class='medium gfield_select' tabindex='84' ><option value='select one that applies' >select one that applies</option><option value='$0 - $250' >$0 - $250</option><option value='$250 - $500' >$250 - $500</option><option value='$500 - $1000' >$500 - $1000</option><option value='$1000 - $1500' >$1000 - $1500</option><option value='$1500 or more' >$1500 or more</option></select></div></li><li id='field_1_59' class='gfield               gfield_contains_required' ><label class='gfield_label' for='input_1_59'>What plans have you made for your pets in case you pass away before they do?<span class='gfield_required'>*</span></label><div class='ginput_container'><textarea name='input_59' id='input_1_59' class='textarea medium' tabindex='85'   rows='10' cols='50'></textarea></div></li></ul>
                    </div>
                    <div class='gform_page_footer'>
                        <input type='button' id='gform_previous_button_1_60' class='button gform_previous_button' value='Previous' tabindex='87' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); '/> <input type='button' id='gform_next_button_1_60' class='button gform_next_button' value='Next' tabindex='86' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); '/>
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                <div id='gform_page_1_3' class='gform_page' style='display:none;'>
                    <div class='gform_page_fields'>
                        <ul class='gform_fields top_label'><li id='field_1_61' class='gfield  gsection' ><h2 class='gsection_title'>Pet Ownership History</h2></li><li id='field_1_62' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever adopted from a Humane Group or Shelter?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_62'><li class='gchoice_62_0'><input name='input_62' type='radio' value='Yes'  id='choice_62_0' tabindex='88'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_0'>Yes</label></li><li class='gchoice_62_1'><input name='input_62' type='radio' value='No'  id='choice_62_1' tabindex='89'  onclick='gf_apply_rules(1,[63,64,65,66]);'  /><label for='choice_62_1'>No</label></li></ul></div></li><li id='field_1_63' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_63'>What Humane Group of Shelter did you adopt from?</label><div class='ginput_container'><input name='input_63' id='input_1_63' type='text' value='' class='medium' tabindex='90' /></div></li><li id='field_1_64' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_64_1'>Humane Group or Shelters address:</label><div class='ginput_complex ginput_container' id='input_1_64'><span class='ginput_full' id='input_1_64_1_container'><input type='text' name='input_64.1' id='input_1_64_1' value='' tabindex='91' /><label for='input_1_64_1' id='input_1_64_1_label'>Street Address</label></span><span class='ginput_left' id='input_1_64_3_container'><input type='text' name='input_64.3' id='input_1_64_3' value='' tabindex='92' /><label for='input_1_64_3' id='input_1_64.3_label'>City</label></span><span class='ginput_right' id='input_1_64_4_container' ><input type='text' name='input_64.4' id='input_1_64_4' value='' tabindex='94'   /><label for='input_1_64_4' id='input_1_64_4_label'>State / Province / Region</label></span><span class='ginput_left' id='input_1_64_5_container'><input type='text' name='input_64.5' id='input_1_64_5' value='' tabindex='95' /><label for='input_1_64_5' id='input_1_64_5_label'>ZIP / Postal Code</label></span><span class='ginput_right' id='input_1_64_6_container' ><select name='input_64.6' id='input_1_64_6' tabindex='96' ><option value='' selected='selected'></option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='C&ocirc;te d&#039;Ivoire' >C&ocirc;te d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Norway' >Norway</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine' >Palestine</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia and Montenegro' >Serbia and Montenegro</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select><label for='input_1_64_6' id='input_1_64_6_label'>Country</label></span><div class='gf_clear gf_clear_complex'></div></div></li><li id='field_1_65' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_65'>Humane Group or Shelters telephone number</label><div class='ginput_container'><input name='input_65' id='input_1_65' type='tel' value='' class='medium' tabindex='97'  /></div></li><li id='field_1_66' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_66'>When did you adopt from a Humane Group or Shelter?</label><div class='clear-multi'><div class='gfield_date_dropdown_month ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='98'  ><option value=''>Month</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option></select></div><div class='gfield_date_dropdown_day ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='99'  ><option value=''>Day</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4' >4</option><option value='5' >5</option><option value='6' >6</option><option value='7' >7</option><option value='8' >8</option><option value='9' >9</option><option value='10' >10</option><option value='11' >11</option><option value='12' >12</option><option value='13' >13</option><option value='14' >14</option><option value='15' >15</option><option value='16' >16</option><option value='17' >17</option><option value='18' >18</option><option value='19' >19</option><option value='20' >20</option><option value='21' >21</option><option value='22' >22</option><option value='23' >23</option><option value='24' >24</option><option value='25' >25</option><option value='26' >26</option><option value='27' >27</option><option value='28' >28</option><option value='29' >29</option><option value='30' >30</option><option value='31' >31</option></select></div><div class='gfield_date_dropdown_year ginput_container' id='input_1_66'><select name='input_66[]' id='input_1_66_1' tabindex='100'  ><option value=''>Year</option><option value='2014' >2014</option><option value='2013' >2013</option><option value='2012' >2012</option><option value='2011' >2011</option><option value='2010' >2010</option><option value='2009' >2009</option><option value='2008' >2008</option><option value='2007' >2007</option><option value='2006' >2006</option><option value='2005' >2005</option><option value='2004' >2004</option><option value='2003' >2003</option><option value='2002' >2002</option><option value='2001' >2001</option><option value='2000' >2000</option><option value='1999' >1999</option><option value='1998' >1998</option><option value='1997' >1997</option><option value='1996' >1996</option><option value='1995' >1995</option><option value='1994' >1994</option><option value='1993' >1993</option><option value='1992' >1992</option><option value='1991' >1991</option><option value='1990' >1990</option><option value='1989' >1989</option><option value='1988' >1988</option><option value='1987' >1987</option><option value='1986' >1986</option><option value='1985' >1985</option><option value='1984' >1984</option><option value='1983' >1983</option><option value='1982' >1982</option><option value='1981' >1981</option><option value='1980' >1980</option><option value='1979' >1979</option><option value='1978' >1978</option><option value='1977' >1977</option><option value='1976' >1976</option><option value='1975' >1975</option><option value='1974' >1974</option><option value='1973' >1973</option><option value='1972' >1972</option><option value='1971' >1971</option><option value='1970' >1970</option><option value='1969' >1969</option><option value='1968' >1968</option><option value='1967' >1967</option><option value='1966' >1966</option><option value='1965' >1965</option><option value='1964' >1964</option><option value='1963' >1963</option><option value='1962' >1962</option><option value='1961' >1961</option><option value='1960' >1960</option><option value='1959' >1959</option><option value='1958' >1958</option><option value='1957' >1957</option><option value='1956' >1956</option><option value='1955' >1955</option><option value='1954' >1954</option><option value='1953' >1953</option><option value='1952' >1952</option><option value='1951' >1951</option><option value='1950' >1950</option><option value='1949' >1949</option><option value='1948' >1948</option><option value='1947' >1947</option><option value='1946' >1946</option><option value='1945' >1945</option><option value='1944' >1944</option><option value='1943' >1943</option><option value='1942' >1942</option><option value='1941' >1941</option><option value='1940' >1940</option><option value='1939' >1939</option><option value='1938' >1938</option><option value='1937' >1937</option><option value='1936' >1936</option><option value='1935' >1935</option><option value='1934' >1934</option><option value='1933' >1933</option><option value='1932' >1932</option><option value='1931' >1931</option><option value='1930' >1930</option><option value='1929' >1929</option><option value='1928' >1928</option><option value='1927' >1927</option><option value='1926' >1926</option><option value='1925' >1925</option><option value='1924' >1924</option><option value='1923' >1923</option><option value='1922' >1922</option><option value='1921' >1921</option><option value='1920' >1920</option></select></div></div></li><li id='field_1_67' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Have you ever given an animal up for adoption?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_67'><li class='gchoice_67_0'><input name='input_67' type='radio' value='Yes'  id='choice_67_0' tabindex='101'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_0'>Yes</label></li><li class='gchoice_67_1'><input name='input_67' type='radio' value='No'  id='choice_67_1' tabindex='102'  onclick='gf_apply_rules(1,[68,69]);'  /><label for='choice_67_1'>No</label></li></ul></div></li><li id='field_1_68' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_68'>Explain why you gave a pet up for adoption:</label><div class='ginput_container'><textarea name='input_68' id='input_1_68' class='textarea medium' tabindex='103'   rows='10' cols='50'></textarea></div></li><li id='field_1_69' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_69'>What did you do with the animal?</label><div class='ginput_container'><textarea name='input_69' id='input_1_69' class='textarea medium' tabindex='104'   rows='10' cols='50'></textarea></div></li><li id='field_1_70' class='gfield    gf_list_4col           gfield_contains_required' ><label class='gfield_label'>Are there currently any other pets in the household?<span class='gfield_required'>*</span></label><div class='ginput_container'><ul class='gfield_radio' id='input_1_70'><li class='gchoice_70_0'><input name='input_70' type='radio' value='Yes'  id='choice_70_0' tabindex='105'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_0'>Yes</label></li><li class='gchoice_70_1'><input name='input_70' type='radio' value='No'  id='choice_70_1' tabindex='106'  onclick='gf_apply_rules(1,[71,73,77]);'  /><label for='choice_70_1'>No</label></li></ul></div></li><li id='field_1_71' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_71'>How many other dogs are in the household?</label><div class='ginput_container'><select name='input_71' id='input_1_71' onchange='gf_apply_rules(1,[72,75]);' class='medium gfield_select' tabindex='107' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_72' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The dog(s) are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_72'><li class='gchoice_72_0'><input name='input_72' type='radio' value='Mostly inside'  id='choice_72_0' tabindex='108'    /><label for='choice_72_0'>Mostly inside</label></li><li class='gchoice_72_1'><input name='input_72' type='radio' value='Totally inside'  id='choice_72_1' tabindex='109'    /><label for='choice_72_1'>Totally inside</label></li><li class='gchoice_72_2'><input name='input_72' type='radio' value='Mostly outside'  id='choice_72_2' tabindex='110'    /><label for='choice_72_2'>Mostly outside</label></li><li class='gchoice_72_3'><input name='input_72' type='radio' value='Totally outside'  id='choice_72_3' tabindex='111'    /><label for='choice_72_3'>Totally outside</label></li><li class='gchoice_72_4'><input name='input_72' type='radio' value='Some are inside dogs and some are outside dogs'  id='choice_72_4' tabindex='112'    /><label for='choice_72_4'>Some are inside dogs and some are outside dogs</label></li></ul></div></li><li id='field_1_75' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the dogs spayed or neutered?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_75'><li class='gchoice_75_0'><input name='input_75' type='radio' value='Yes'  id='choice_75_0' tabindex='113'    /><label for='choice_75_0'>Yes</label></li><li class='gchoice_75_1'><input name='input_75' type='radio' value='No'  id='choice_75_1' tabindex='114'    /><label for='choice_75_1'>No</label></li></ul></div></li><li id='field_1_73' class='gfield' style='display:none;'><label class='gfield_label' for='input_1_73'>How many cats are in the household?</label><div class='ginput_container'><select name='input_73' id='input_1_73' onchange='gf_apply_rules(1,[74,76]);' class='medium gfield_select' tabindex='115' ><option value='select one that applies' >select one that applies</option><option value='0' >0</option><option value='1' >1</option><option value='2' >2</option><option value='3' >3</option><option value='4 or more' >4 or more</option></select></div></li><li id='field_1_74' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>The cats are kept:</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_74'><li class='gchoice_74_0'><input name='input_74' type='radio' value='Mostly inside'  id='choice_74_0' tabindex='116'    /><label for='choice_74_0'>Mostly inside</label></li><li class='gchoice_74_1'><input name='input_74' type='radio' value='Totally inside'  id='choice_74_1' tabindex='117'    /><label for='choice_74_1'>Totally inside</label></li><li class='gchoice_74_2'><input name='input_74' type='radio' value='Mostly outside'  id='choice_74_2' tabindex='118'    /><label for='choice_74_2'>Mostly outside</label></li><li class='gchoice_74_3'><input name='input_74' type='radio' value='Totally outside'  id='choice_74_3' tabindex='119'    /><label for='choice_74_3'>Totally outside</label></li><li class='gchoice_74_4'><input name='input_74' type='radio' value='Some are inside cats and some are outside cats'  id='choice_74_4' tabindex='120'    /><label for='choice_74_4'>Some are inside cats and some are outside cats</label></li></ul></div></li><li id='field_1_76' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Do dogs and cats live in the same area?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_76'><li class='gchoice_76_0'><input name='input_76' type='radio' value='Yes'  id='choice_76_0' tabindex='121'    /><label for='choice_76_0'>Yes</label></li><li class='gchoice_76_1'><input name='input_76' type='radio' value='No'  id='choice_76_1' tabindex='122'    /><label for='choice_76_1'>No</label></li></ul></div></li><li id='field_1_77' class='gfield    gf_list_4col' style='display:none;'><label class='gfield_label'>Are all the pets in your household current on their shots?</label><div class='ginput_container'><ul class='gfield_radio' id='input_1_77'><li class='gchoice_77_0'><input name='input_77' type='radio' value='Yes'  id='choice_77_0' tabindex='123'    /><label for='choice_77_0'>Yes</label></li><li class='gchoice_77_1'><input name='input_77' type='radio' value='No'  id='choice_77_1' tabindex='124'    /><label for='choice_77_1'>No</label></li></ul></div></li><li id='field_1_78' class='gfield' ><label class='gfield_label' for='input_1_78'>Where did you hear about the Humane Society of Cozumel Island?</label><div class='ginput_container'><textarea name='input_78' id='input_1_78' class='textarea medium' tabindex='125'   rows='10' cols='50'></textarea></div></li><li id='field_1_79' class='gfield      gfield_html gfield_html_formatted gfield_no_follows_desc' >by clicking the "Submit" button below you effectively sign and confirm that all the information in this application is complete to the best of your knowledge.
<br />
Any information provided is used solely in connection with the HSCI process. We do not share your information with any third parties nor do we contact you concerning matters other than the adoption.
<br />
Please make sure you have answered all relevant questions prior to submitting the form.
</li><li id='field_1_86' class='gfield    gform_validation_container' ><label class='gfield_label' for='input_1_86'>Phone</label><div class='ginput_container'><input name='input_86' id='input_1_86' type='text' value='' autocomplete='off'/></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='button gform_previous_button' value='Previous' tabindex='126' /> <input type='submit' id='gform_submit_button_1' class='button gform_button' value='Submit' tabindex='127' /><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=1&amp;description=1' />
            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' />
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