{"id":4431,"date":"2019-01-03T17:39:37","date_gmt":"2019-01-04T01:39:37","guid":{"rendered":"https:\/\/thelifelinecanada.ca\/?page_id=4431"},"modified":"2021-02-24T15:41:10","modified_gmt":"2021-02-24T23:41:10","slug":"assisted-therapy-dog-adoption-application","status":"publish","type":"page","link":"https:\/\/companionpaws.ca\/fr\/assisted-therapy-dog-adoption-application\/","title":{"rendered":"Assisted Therapy Dog Adoption Application"},"content":{"rendered":"<p>Cette application est destin\u00e9e au programme d&#8217;adoption de chiens de th\u00e9rapie assist\u00e9e Companion Paws de TLC. Pour les \u00e9ducateurs, les enseignants, les m\u00e9decins, les professionnels de la sant\u00e9 mentale, les th\u00e9rapeutes et les professionnels qui am\u00e8neront leur chien de th\u00e9rapie certifi\u00e9 pour travailler avec eux pour soutenir leurs \u00e9tudiants, leurs clients et leurs patients.<\/p>\n<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-4\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-4\" value=\"1775415165\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"4\" id=\"\"><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField88\"><div class=\"vfb-form-group\"><label for=\"vfb-field-88\" class=\"vfb-control-label\">Name <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-88\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-88\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField89\"><div class=\"vfb-form-group\"><label for=\"vfb-field-89\" class=\"vfb-control-label\">Age <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-89\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-89\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField90\"><div class=\"vfb-form-group\"><label for=\"vfb-field-90\" class=\"vfb-control-label\">Email <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-90\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-90\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-phone\" id=\"vfbField184\"><div class=\"vfb-form-group\"><label for=\"vfb-field-184\" class=\"vfb-control-label\">Phone <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-184\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" required=\"required\" data-default-country=\"ca\" data-hide-flags=\"1\" type=\"tel\" name=\"vfb-field-184\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-address\" id=\"vfbField92\"><div class=\"vfb-form-group\"><label for=\"vfb-field-92\" class=\"vfb-control-label\">Address <span class=\"vfb-required-asterisk\">*<\/span><\/label><div class=\"vfb-address-block\" id=\"vfb-field-92\"><div class=\"vfb-form-group\" style=\"\"><input id=\"vfb-field-92-address-1\" class=\"vfb-form-control vfb-addresspart-address-1\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-92[address-1]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-92-address-2\" class=\"vfb-address-label\">Apt, suite, etc.<\/label><input id=\"vfb-field-92-address-2\" class=\"vfb-form-control vfb-addresspart-address-2\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-92[address-2]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-92-country\" class=\"vfb-address-label\">Country<\/label><select id=\"vfb-field-92-country\" class=\"vfb-form-control vfb-addresspart-country\" placeholder=\"\" required=\"required\" name=\"vfb-field-92[country]\"><option value=\"US\">United States (US)<\/option><option value=\"GB\">United Kingdom (UK)<\/option><option value=\"CA\" selected='selected'>Canada<\/option><option value=\"AU\">Australia<\/option><option value=\"\">---<\/option><option value=\"AF\">Afghanistan<\/option><option value=\"AX\">&#197;land Islands<\/option><option value=\"AL\">Albania<\/option><option value=\"DZ\">Algeria<\/option><option value=\"AD\">Andorra<\/option><option value=\"AO\">Angola<\/option><option value=\"AI\">Anguilla<\/option><option value=\"AQ\">Antarctica<\/option><option value=\"AG\">Antigua and Barbuda<\/option><option value=\"AR\">Argentina<\/option><option value=\"AM\">Armenia<\/option><option value=\"AW\">Aruba<\/option><option value=\"AS\">American Samoa<\/option><option value=\"AT\">Austria<\/option><option value=\"AZ\">Azerbaijan<\/option><option value=\"BS\">Bahamas<\/option><option value=\"BH\">Bahrain<\/option><option value=\"BD\">Bangladesh<\/option><option value=\"BB\">Barbados<\/option><option value=\"BY\">Belarus<\/option><option value=\"BE\">Belgium<\/option><option value=\"PW\">Belau<\/option><option value=\"BZ\">Belize<\/option><option value=\"BJ\">Benin<\/option><option value=\"BM\">Bermuda<\/option><option value=\"BT\">Bhutan<\/option><option value=\"BO\">Bolivia<\/option><option value=\"BQ\">Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\">Bosnia and Herzegovina<\/option><option value=\"BW\">Botswana<\/option><option value=\"BV\">Bouvet Island<\/option><option value=\"BR\">Brazil<\/option><option value=\"IO\">British Indian Ocean Territory<\/option><option value=\"VG\">British Virgin Islands<\/option><option value=\"BN\">Brunei<\/option><option value=\"BG\">Bulgaria<\/option><option value=\"BF\">Burkina Faso<\/option><option value=\"BI\">Burundi<\/option><option value=\"KH\">Cambodia<\/option><option value=\"CM\">Cameroon<\/option><option value=\"CV\">Cape Verde<\/option><option value=\"KY\">Cayman Islands<\/option><option value=\"CF\">Central African Republic<\/option><option value=\"TD\">Chad<\/option><option value=\"CL\">Chile<\/option><option value=\"CN\">China<\/option><option value=\"CX\">Christmas Island<\/option><option value=\"CC\">Cocos (Keeling) Islands<\/option><option value=\"CO\">Colombia<\/option><option value=\"KM\">Comoros<\/option><option value=\"CG\">Congo (Brazzaville)<\/option><option value=\"CD\">Congo (Kinshasa)<\/option><option value=\"CK\">Cook Islands<\/option><option value=\"CR\">Costa Rica<\/option><option value=\"HR\">Croatia<\/option><option value=\"CU\">Cuba<\/option><option value=\"CW\">Cura&Ccedil;ao<\/option><option value=\"CY\">Cyprus<\/option><option value=\"CZ\">Czech Republic<\/option><option value=\"DK\">Denmark<\/option><option value=\"DJ\">Djibouti<\/option><option value=\"DM\">Dominica<\/option><option value=\"DO\">Dominican Republic<\/option><option value=\"EC\">Ecuador<\/option><option value=\"EG\">Egypt<\/option><option value=\"SV\">El Salvador<\/option><option value=\"GQ\">Equatorial Guinea<\/option><option value=\"ER\">Eritrea<\/option><option value=\"EE\">Estonia<\/option><option value=\"ET\">Ethiopia<\/option><option value=\"FK\">Falkland Islands<\/option><option value=\"FO\">Faroe Islands<\/option><option value=\"FJ\">Fiji<\/option><option value=\"FI\">Finland<\/option><option value=\"FR\">France<\/option><option value=\"GF\">French Guiana<\/option><option value=\"PF\">French Polynesia<\/option><option value=\"TF\">French Southern Territories<\/option><option value=\"GA\">Gabon<\/option><option value=\"GM\">Gambia<\/option><option value=\"GE\">Georgia<\/option><option value=\"DE\">Germany<\/option><option value=\"GH\">Ghana<\/option><option value=\"GI\">Gibraltar<\/option><option value=\"GR\">Greece<\/option><option value=\"GL\">Greenland<\/option><option value=\"GD\">Grenada<\/option><option value=\"GP\">Guadeloupe<\/option><option value=\"GT\">Guatemala<\/option><option value=\"GG\">Guernsey<\/option><option value=\"GN\">Guinea<\/option><option value=\"GW\">Guinea-Bissau<\/option><option value=\"GY\">Guyana<\/option><option value=\"HT\">Haiti<\/option><option value=\"HM\">Heard Island and McDonald Islands<\/option><option value=\"HN\">Honduras<\/option><option value=\"HK\">Hong Kong<\/option><option value=\"HU\">Hungary<\/option><option value=\"IS\">Iceland<\/option><option value=\"IN\">India<\/option><option value=\"ID\">Indonesia<\/option><option value=\"IR\">Iran<\/option><option value=\"IQ\">Iraq<\/option><option value=\"IE\">Republic of Ireland<\/option><option value=\"IM\">Isle of Man<\/option><option value=\"IL\">Israel<\/option><option value=\"IT\">Italy<\/option><option value=\"CI\">Ivory Coast<\/option><option value=\"JM\">Jamaica<\/option><option value=\"JP\">Japan<\/option><option value=\"JE\">Jersey<\/option><option value=\"JO\">Jordan<\/option><option value=\"KZ\">Kazakhstan<\/option><option value=\"KE\">Kenya<\/option><option value=\"KI\">Kiribati<\/option><option value=\"KW\">Kuwait<\/option><option value=\"KG\">Kyrgyzstan<\/option><option value=\"LA\">Laos<\/option><option value=\"LV\">Latvia<\/option><option value=\"LB\">Lebanon<\/option><option value=\"LS\">Lesotho<\/option><option value=\"LR\">Liberia<\/option><option value=\"LY\">Libya<\/option><option value=\"LI\">Liechtenstein<\/option><option value=\"LT\">Lithuania<\/option><option value=\"LU\">Luxembourg<\/option><option value=\"MO\">Macao S.A.R., China<\/option><option value=\"MK\">Macedonia<\/option><option value=\"MG\">Madagascar<\/option><option value=\"MW\">Malawi<\/option><option value=\"MY\">Malaysia<\/option><option value=\"MV\">Maldives<\/option><option value=\"ML\">Mali<\/option><option value=\"MT\">Malta<\/option><option value=\"MH\">Marshall Islands<\/option><option value=\"MQ\">Martinique<\/option><option value=\"MR\">Mauritania<\/option><option value=\"MU\">Mauritius<\/option><option value=\"YT\">Mayotte<\/option><option value=\"MX\">Mexico<\/option><option value=\"FM\">Micronesia<\/option><option value=\"MD\">Moldova<\/option><option value=\"MC\">Monaco<\/option><option value=\"MN\">Mongolia<\/option><option value=\"ME\">Montenegro<\/option><option value=\"MS\">Montserrat<\/option><option value=\"MA\">Morocco<\/option><option value=\"MZ\">Mozambique<\/option><option value=\"MM\">Myanmar<\/option><option value=\"NA\">Namibia<\/option><option value=\"NR\">Nauru<\/option><option value=\"NP\">Nepal<\/option><option value=\"NL\">Netherlands<\/option><option value=\"AN\">Netherlands Antilles<\/option><option value=\"NC\">New Caledonia<\/option><option value=\"NZ\">New Zealand<\/option><option value=\"NI\">Nicaragua<\/option><option value=\"NE\">Niger<\/option><option value=\"NG\">Nigeria<\/option><option value=\"NU\">Niue<\/option><option value=\"NF\">Norfolk Island<\/option><option value=\"KP\">North Korea<\/option><option value=\"NO\">Norway<\/option><option value=\"OM\">Oman<\/option><option value=\"PK\">Pakistan<\/option><option value=\"PS\">Palestinian Territory<\/option><option value=\"PA\">Panama<\/option><option value=\"PG\">Papua New Guinea<\/option><option value=\"PY\">Paraguay<\/option><option value=\"PE\">Peru<\/option><option value=\"PH\">Philippines<\/option><option value=\"PN\">Pitcairn<\/option><option value=\"PL\">Poland<\/option><option value=\"PT\">Portugal<\/option><option value=\"QA\">Qatar<\/option><option value=\"RE\">Reunion<\/option><option value=\"RO\">Romania<\/option><option value=\"RU\">Russia<\/option><option value=\"RW\">Rwanda<\/option><option value=\"BL\">Saint Barth&eacute;lemy<\/option><option value=\"SH\">Saint Helena<\/option><option value=\"KN\">Saint Kitts and Nevis<\/option><option value=\"LC\">Saint Lucia<\/option><option value=\"MF\">Saint Martin (French part)<\/option><option value=\"SX\">Saint Martin (Dutch part)<\/option><option value=\"PM\">Saint Pierre and Miquelon<\/option><option value=\"VC\">Saint Vincent and the Grenadines<\/option><option value=\"SM\">San Marino<\/option><option value=\"ST\">S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value=\"SA\">Saudi Arabia<\/option><option value=\"SN\">Senegal<\/option><option value=\"RS\">Serbia<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra Leone<\/option><option value=\"SG\">Singapore<\/option><option value=\"SK\">Slovakia<\/option><option value=\"SI\">Slovenia<\/option><option value=\"SB\">Solomon Islands<\/option><option value=\"SO\">Somalia<\/option><option value=\"ZA\">South Africa<\/option><option value=\"GS\">South Georgia\/Sandwich Islands<\/option><option value=\"KR\">South Korea<\/option><option value=\"SS\">South Sudan<\/option><option value=\"ES\">Spain<\/option><option value=\"LK\">Sri Lanka<\/option><option value=\"SD\">Sudan<\/option><option value=\"SR\">Suriname<\/option><option value=\"SJ\">Svalbard and Jan Mayen<\/option><option value=\"SZ\">Swaziland<\/option><option value=\"SE\">Sweden<\/option><option value=\"CH\">Switzerland<\/option><option value=\"SY\">Syria<\/option><option value=\"TW\">Taiwan<\/option><option value=\"TJ\">Tajikistan<\/option><option value=\"TZ\">Tanzania<\/option><option value=\"TH\">Thailand<\/option><option value=\"TL\">Timor-Leste<\/option><option value=\"TG\">Togo<\/option><option value=\"TK\">Tokelau<\/option><option value=\"TO\">Tonga<\/option><option value=\"TT\">Trinidad and Tobago<\/option><option value=\"TN\">Tunisia<\/option><option value=\"TR\">Turkey<\/option><option value=\"TM\">Turkmenistan<\/option><option value=\"TC\">Turks and Caicos Islands<\/option><option value=\"TV\">Tuvalu<\/option><option value=\"UG\">Uganda<\/option><option value=\"UA\">Ukraine<\/option><option value=\"AE\">United Arab Emirates<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UZ\">Uzbekistan<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VA\">Vatican<\/option><option value=\"VE\">Venezuela<\/option><option value=\"VN\">Vietnam<\/option><option value=\"WF\">Wallis and Futuna<\/option><option value=\"EH\">Western Sahara<\/option><option value=\"WS\">Western Samoa<\/option><option value=\"YE\">Yemen<\/option><option value=\"ZM\">Zambia<\/option><option value=\"ZW\">Zimbabwe<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-92-city\" class=\"vfb-address-label\">City<\/label><input id=\"vfb-field-92-city\" class=\"vfb-form-control vfb-addresspart-city\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-92[city]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-92-province\" class=\"vfb-address-label\">State<\/label><select id=\"vfb-field-92-province\" class=\"vfb-form-control vfb-addresspart-province\" placeholder=\"\" required=\"required\" name=\"vfb-field-92[province]\"><option value=\"\"><\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District Of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\">Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option><option value=\"AA\">Armed Forces (AA)<\/option><option value=\"AE\">Armed Forces (AE)<\/option><option value=\"AP\">Armed Forces (AP)<\/option><option value=\"AS\">American Samoa<\/option><option value=\"GU\">Guam<\/option><option value=\"MP\">Northern Mariana Islands<\/option><option value=\"PR\">Puerto Rico<\/option><option value=\"UM\">US Minor Outlying Islands<\/option><option value=\"VI\">US Virgin Islands<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-92-zip\" class=\"vfb-address-label\">Zip code<\/label><input id=\"vfb-field-92-zip\" class=\"vfb-form-control vfb-addresspart-zip\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-92[zip]\"><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-file-upload\" id=\"vfbField93\"><div class=\"vfb-form-group\"><label for=\"vfb-field-93\" class=\"vfb-control-label\">Please upload a letter stating the date, your profession, location of where the dog will be attending with you and details of what the dog will be doing for your students, clients or patients <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-93\" class=\"vfb-form-control vfb-file-input\" placeholder=\"\" required=\"required\" type=\"file\" name=\"vfb-field-93\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField94\"><div class=\"vfb-form-group\"><label for=\"vfb-field-94\" class=\"vfb-control-label\">Names, ages, occupation and relationships of all members of household: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea id=\"vfb-field-94\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"10\" name=\"vfb-field-94\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField95\"><label for=\"vfb-field-95\" class=\"vfb-control-label\">What kind of family home do you live in? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-95-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-95\" required=\"required\" type=\"checkbox\" name=\"vfb-field-95[0]\" value=\"1\">Single Family<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-95-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-95\" type=\"checkbox\" name=\"vfb-field-95[1]\" value=\"1\">Townhouse<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-95-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-95\" type=\"checkbox\" name=\"vfb-field-95[2]\" value=\"1\">Condo<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-95-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-95\" type=\"checkbox\" name=\"vfb-field-95[3]\" value=\"1\">Apartment<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-95-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-95\" type=\"checkbox\" name=\"vfb-field-95[4]\" value=\"1\">Mobile<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-95-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-95\" type=\"checkbox\" name=\"vfb-field-95[5]\" value=\"1\">Farm<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-95-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-95\" type=\"checkbox\" name=\"vfb-field-95[6]\" value=\"1\">Duplex<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-95-7\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-95\" type=\"checkbox\" name=\"vfb-field-95[7]\" value=\"1\">Student Housing<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField96\"><div class=\"vfb-form-group\"><label for=\"vfb-field-96\" class=\"vfb-control-label\">Home size (square footage) <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-96\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-96\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField97\"><div class=\"vfb-form-group\"><label for=\"vfb-field-97\" class=\"vfb-control-label\">What is the size if your property? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-97\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-97\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField98\"><label for=\"vfb-field-98\" class=\"vfb-control-label\">Do you live in a rental unit? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-98-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-98\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-98-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-98\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-file-upload\" id=\"vfbField99\"><div class=\"vfb-form-group\"><label for=\"vfb-field-99\" class=\"vfb-control-label\">If renting, please upload a letter (pdf format) from your landlord stating that permission to keep a dog on the property is granted.<\/label><div><input id=\"vfb-field-99\" class=\"vfb-form-control vfb-file-input\" placeholder=\"\" type=\"file\" name=\"vfb-field-99\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField100\"><div class=\"vfb-form-group\"><label for=\"vfb-field-100\" class=\"vfb-control-label\">How long have you lived in your home? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-100\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-100\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField101\"><label for=\"vfb-field-101\" class=\"vfb-control-label\">Do you have a fully fenced yard? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-101-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-101\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-101-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-101\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField102\"><div class=\"vfb-form-group\"><label for=\"vfb-field-102\" class=\"vfb-control-label\">Please describe size, height and type of fencing. <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-102\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-102\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField103\"><div class=\"vfb-form-group\"><label for=\"vfb-field-103\" class=\"vfb-control-label\">If not fully fenced, how will you keep your dog safe while it is outside? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-103\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-103\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField104\"><label for=\"vfb-field-104\" class=\"vfb-control-label\">How would you describe your household? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-104-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-104\" required=\"required\" type=\"checkbox\" name=\"vfb-field-104[0]\" value=\"1\">Loud<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-104-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-104\" type=\"checkbox\" name=\"vfb-field-104[1]\" value=\"1\">Calm<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-104-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-104\" type=\"checkbox\" name=\"vfb-field-104[2]\" value=\"1\">Busy<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-104-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-104\" type=\"checkbox\" name=\"vfb-field-104[3]\" value=\"1\">Quiet<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField105\"><div class=\"vfb-form-group\"><label for=\"vfb-field-105\" class=\"vfb-control-label\">How much interaction has\/have you and your child(ren) had with dogs in the past? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea id=\"vfb-field-105\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"10\" name=\"vfb-field-105\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField106\"><div class=\"vfb-form-group\"><label for=\"vfb-field-106\" class=\"vfb-control-label\">Does anyone in the home have known allergies to dogs? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-106\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-106\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField107\"><div class=\"vfb-form-group\"><label for=\"vfb-field-107\" class=\"vfb-control-label\">Are you looking for a particular size, sex or age of dog? If so, why? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-107\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-107\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField108\"><div class=\"vfb-form-group\"><label for=\"vfb-field-108\" class=\"vfb-control-label\">Please describe your perfect Assisted companion pet  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea id=\"vfb-field-108\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"10\" name=\"vfb-field-108\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField109\"><div class=\"vfb-form-group\"><label for=\"vfb-field-109\" class=\"vfb-control-label\">What does adopting a rescue dog mean to you? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-109\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-109\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField110\"><label for=\"vfb-field-110\" class=\"vfb-control-label\">Have you previously ever adopted a dog? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-110-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-110\" required=\"required\" type=\"checkbox\" name=\"vfb-field-110[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-110-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-110\" type=\"checkbox\" name=\"vfb-field-110[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField111\"><label for=\"vfb-field-111\" class=\"vfb-control-label\">Do you currently have any pets? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-111-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-111\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-111-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-111\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField112\"><div class=\"vfb-form-group\"><label for=\"vfb-field-112\" class=\"vfb-control-label\">Number, Type and Description of any other pets in the house <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea id=\"vfb-field-112\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"10\" name=\"vfb-field-112\" cols=\"50\"><\/textarea><span class=\"vfb-help-block\">Write N\/A if not applicable<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField113\"><label for=\"vfb-field-113\" class=\"vfb-control-label\">Are these pets spayed or neutered? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-113-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-113\" required=\"required\" type=\"checkbox\" name=\"vfb-field-113[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-113-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-113\" type=\"checkbox\" name=\"vfb-field-113[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField114\"><label for=\"vfb-field-114\" class=\"vfb-control-label\">Are these pets up to date on vaccines? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-114-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-114\" required=\"required\" type=\"checkbox\" name=\"vfb-field-114[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-114-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-114\" type=\"checkbox\" name=\"vfb-field-114[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField115\"><div class=\"vfb-form-group\"><label for=\"vfb-field-115\" class=\"vfb-control-label\">Have you previously owned any pets in the last 10 years (other than any you may have now), and what became of those pets? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-115\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-115\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField116\"><div class=\"vfb-form-group\"><label for=\"vfb-field-116\" class=\"vfb-control-label\">Where do current pets\/did previous pets spend most of their time? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-116\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-116\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField117\"><div class=\"vfb-form-group\"><label for=\"vfb-field-117\" class=\"vfb-control-label\">What are you currently feeding your dogs (type of food and brand)? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-117\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-117\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField118\"><div class=\"vfb-form-group\"><label for=\"vfb-field-118\" class=\"vfb-control-label\">Are you capable of caring for a companion animal? (Exercising, walking, feeding, playing, grooming, and training) <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-118\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-118\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField119\"><div class=\"vfb-form-group\"><label for=\"vfb-field-119\" class=\"vfb-control-label\">What is the work schedule of the family members, and how long would a dog be in your home alone? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea id=\"vfb-field-119\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"10\" name=\"vfb-field-119\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField120\"><div class=\"vfb-form-group\"><label for=\"vfb-field-120\" class=\"vfb-control-label\">How and how long do you plan to exercise a dog both on-leash and off-leash? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-120\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-120\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField121\"><div class=\"vfb-form-group\"><label for=\"vfb-field-121\" class=\"vfb-control-label\">Describe your current daily activities. <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea id=\"vfb-field-121\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"10\" name=\"vfb-field-121\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField122\"><div class=\"vfb-form-group\"><label for=\"vfb-field-122\" class=\"vfb-control-label\">Where will the dog spend the day? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-122\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-122\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField123\"><div class=\"vfb-form-group\"><label for=\"vfb-field-123\" class=\"vfb-control-label\">Where will the dog spend the night? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-123\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-123\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField124\"><div class=\"vfb-form-group\"><label for=\"vfb-field-124\" class=\"vfb-control-label\">Number of hours (average) dog will spend alone? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-124\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-124\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField125\"><div class=\"vfb-form-group\"><label for=\"vfb-field-125\" class=\"vfb-control-label\">What are your thoughts on crate training? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-125\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-125\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField126\"><label for=\"vfb-field-126\" class=\"vfb-control-label\">Under what circumstances would you not keep the dog? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" required=\"required\" type=\"checkbox\" name=\"vfb-field-126[0]\" value=\"1\">Divorce<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[1]\" value=\"1\">Illness in Family<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[2]\" value=\"1\">Going to bathroom in house<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[3]\" value=\"1\">New Baby<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[4]\" value=\"1\">Moving<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[5]\" value=\"1\">Escaping from house\/yard<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[6]\" value=\"1\">New job<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-7\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[7]\" value=\"1\">Allergy<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-8\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[8]\" value=\"1\">New partner allergic \/ doesn\\'t like dog<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-9\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[9]\" value=\"1\">Chewing<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-10\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[10]\" value=\"1\">Barking<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-11\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[11]\" value=\"1\">Dog became ill \/high vet bills<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-12\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[12]\" value=\"1\">Digging<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-13\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[13]\" value=\"1\">Shedding too much<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-14\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[14]\" value=\"1\">Being destructive in the house (furniture, shoes, etc)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-15\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[15]\" value=\"1\">Dog grew too big<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-16\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[16]\" value=\"1\">Biting<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-17\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[17]\" value=\"1\">Kids ignore the dog<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-18\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[18]\" value=\"1\">Pets didn\\'t get along<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-19\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[19]\" value=\"1\">Not obedient enough<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-20\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[20]\" value=\"1\">Redeployment<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-126-21\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-126\" type=\"checkbox\" name=\"vfb-field-126[21]\" value=\"1\">Other<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField127\"><div class=\"vfb-form-group\"><label for=\"vfb-field-127\" class=\"vfb-control-label\">If 'other', please specify.<\/label><div><input id=\"vfb-field-127\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-127\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField128\"><div class=\"vfb-form-group\"><label for=\"vfb-field-128\" class=\"vfb-control-label\">If you were to move in the future, what would happen to your dog? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-128\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-128\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField129\"><label for=\"vfb-field-129\" class=\"vfb-control-label\">Have you ever surrendered a pet? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-129-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-129\" required=\"required\" type=\"checkbox\" name=\"vfb-field-129[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-129-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-129\" type=\"checkbox\" name=\"vfb-field-129[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField130\"><div class=\"vfb-form-group\"><label for=\"vfb-field-130\" class=\"vfb-control-label\">If yes, please tell us why.<\/label><div><input id=\"vfb-field-130\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-130\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField131\"><div class=\"vfb-form-group\"><label for=\"vfb-field-131\" class=\"vfb-control-label\">Explain how you will be able to manage the training of the dog in accordance to your current work \/ leisure schedule <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea id=\"vfb-field-131\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"10\" name=\"vfb-field-131\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField132\"><label for=\"vfb-field-132\" class=\"vfb-control-label\">Do you intend to take the dog for regular medical checkups and keep vaccinations up to date? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-132-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-132\" required=\"required\" type=\"checkbox\" name=\"vfb-field-132[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-132-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-132\" type=\"checkbox\" name=\"vfb-field-132[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField133\"><label for=\"vfb-field-133\" class=\"vfb-control-label\">Are you willing and able to pay for any future medical needs of your pet which can average $1,200\/year? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-133-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-133\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-133-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-133\" value=\"No\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField134\"><div class=\"vfb-form-group\"><label for=\"vfb-field-134\" class=\"vfb-control-label\">Name and contact information of your Veterinarian\/Clinic you will be using<\/label><div><input id=\"vfb-field-134\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-134\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField135\"><label for=\"vfb-field-135\" class=\"vfb-control-label\">Do you agree to provide regular health care by a licensed Veterinarian? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-135-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-135\" required=\"required\" type=\"checkbox\" name=\"vfb-field-135[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-135-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-135\" type=\"checkbox\" name=\"vfb-field-135[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField136\"><label for=\"vfb-field-136\" class=\"vfb-control-label\">Do you agree to keep the dog as an indoor pet? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-136-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-136\" required=\"required\" type=\"checkbox\" name=\"vfb-field-136[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-136-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-136\" type=\"checkbox\" name=\"vfb-field-136[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField137\"><div class=\"vfb-form-group\"><label for=\"vfb-field-137\" class=\"vfb-control-label\">Have you talked to all of the people in your household about adding a dog to the household, and do they agree? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-137\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-137\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField138\"><div class=\"vfb-form-group\"><label for=\"vfb-field-138\" class=\"vfb-control-label\">When traveling\/away from home, what arrangements will you make for the care of your dog? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-138\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-138\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField139\"><label for=\"vfb-field-139\" class=\"vfb-control-label\">Are you prepared to make the 10-15 year commitment a dog requires? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-139-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-139\" required=\"required\" type=\"checkbox\" name=\"vfb-field-139[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-139-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-139\" type=\"checkbox\" name=\"vfb-field-139[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField140\"><label for=\"vfb-field-140\" class=\"vfb-control-label\">Are you willing to let a representative of Companion Paws or the Rescue have a home visit by appointment? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-140-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-140\" required=\"required\" type=\"checkbox\" name=\"vfb-field-140[0]\" value=\"1\">Yes<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-140-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-140\" type=\"checkbox\" name=\"vfb-field-140[1]\" value=\"1\">No<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField141\"><div class=\"vfb-form-group\"><label for=\"vfb-field-141\" class=\"vfb-control-label\">Any additional information you would like to add?<\/label><div><input id=\"vfb-field-141\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-141\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField142\"><div class=\"vfb-form-group\"><label for=\"vfb-field-142\" class=\"vfb-control-label\">Reference #1 (Name, phone number and relationship) No more than one relative or family member <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-142\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-142\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField143\"><div class=\"vfb-form-group\"><label for=\"vfb-field-143\" class=\"vfb-control-label\">Reference #2 (Name, phone number and relationship) No more than one relative or family member <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-143\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-143\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField144\"><div class=\"vfb-form-group\"><label for=\"vfb-field-144\" class=\"vfb-control-label\">Reference #3 (Name, phone number and relationship) No more than one relative or family member<\/label><div><input id=\"vfb-field-144\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-144\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField145\"><button id=\"vfb-field-145\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/form>\n","protected":false},"excerpt":{"rendered":"<p>Cette application est destin\u00e9e au programme d&#8217;adoption de chiens de [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"_links":{"self":[{"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/pages\/4431"}],"collection":[{"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/comments?post=4431"}],"version-history":[{"count":3,"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/pages\/4431\/revisions"}],"predecessor-version":[{"id":5043,"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/pages\/4431\/revisions\/5043"}],"wp:attachment":[{"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/media?parent=4431"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}