{"id":314,"date":"2021-09-02T22:09:29","date_gmt":"2021-09-02T22:09:29","guid":{"rendered":"http:\/\/www.molineanimalaid.org\/site\/?page_id=314"},"modified":"2022-05-02T16:29:50","modified_gmt":"2022-05-02T16:29:50","slug":"pet-adoption","status":"publish","type":"page","link":"https:\/\/www.molineanimalaid.org\/site\/pet-adoption\/","title":{"rendered":"Pet Pre-Adoption Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-283\"><form id=\"wpforms-form-283\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"283\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/site\/wp-json\/wp\/v2\/pages\/314\" data-token=\"6c7c3e6523af1d6399a43467b0479c9b\" data-token-time=\"1776774902\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-283-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_3\">Requested Pet&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-283-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-283-field_21-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Animal Type <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-283-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_21_1\" name=\"wpforms[fields][21][]\" value=\"Cat\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_21_1\">Cat<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_21_2\" name=\"wpforms[fields][21][]\" value=\"Kitten\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_21_2\">Kitten<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_21_3\" name=\"wpforms[fields][21][]\" value=\"Dog\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_21_3\">Dog<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_21_4\" name=\"wpforms[fields][21][]\" value=\"Puppy\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_21_4\">Puppy<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_21_5\" name=\"wpforms[fields][21][]\" value=\"Rabbit\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_21_5\">Rabbit<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_21_6\" name=\"wpforms[fields][21][]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_21_6\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-283-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_23\">AAHS ID #<\/label><input type=\"text\" id=\"wpforms-283-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" ><\/div><div id=\"wpforms-283-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_22\">MicroChip # if known<\/label><input type=\"text\" id=\"wpforms-283-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" ><\/div><div id=\"wpforms-283-field_24-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"24\"><label class=\"wpforms-field-label\">Where did you view the animal?<\/label><ul id=\"wpforms-283-field_24\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_24_1\" name=\"wpforms[fields][24][]\" value=\"AAHS\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_24_1\">AAHS<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_24_2\" name=\"wpforms[fields][24][]\" value=\"Petco Moline\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_24_2\">Petco Moline<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_24_6\" name=\"wpforms[fields][24][]\" value=\"Other\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_24_6\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-283-field_16-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"16\"><h3 id=\"wpforms-283-field_16\">Personal Information<\/h3><\/div><div id=\"wpforms-283-field_38-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_38\">Are you a student? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-283-field_38\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][38]\" required=\"required\"><option value=\"No\" >No<\/option><option value=\"Yes\" >Yes<\/option><\/select><\/div><div id=\"wpforms-283-field_27-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_27\">Date of Birth<\/label><input type=\"number\" id=\"wpforms-283-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" step=\"any\" ><\/div><div id=\"wpforms-283-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Adoptor&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-283-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-283-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-283-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-283-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-283-field_5-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"5\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-283-field_5\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][5][address1]\" required><label for=\"wpforms-283-field_5\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-283-field_5-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][5][address2]\" ><label for=\"wpforms-283-field_5-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-283-field_5-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][5][city]\" required><label for=\"wpforms-283-field_5-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-283-field_5-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][5][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/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><\/select><label for=\"wpforms-283-field_5-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-283-field_5-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][5][postal]\" required><label for=\"wpforms-283-field_5-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-283-field_4-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_4\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-283-field_4\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][4]\" aria-label=\"Phone\" required><\/div><div id=\"wpforms-283-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-283-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-283-field_48-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"48\"><label class=\"wpforms-field-label\">Work History<\/label><ul id=\"wpforms-283-field_48\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-283-field_48_1\" name=\"wpforms[fields][48]\" value=\"Retired\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_48_1\">Retired<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-283-field_48_2\" name=\"wpforms[fields][48]\" value=\"Employed\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_48_2\">Employed<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-283-field_48_3\" name=\"wpforms[fields][48]\" value=\"Self Employed\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_48_3\">Self Employed<\/label><\/li><\/ul><\/div><div id=\"wpforms-283-field_45-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_45\">Employer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-283-field_45\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][45]\" required><\/div><div id=\"wpforms-283-field_47-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_47\">Address<\/label><input type=\"text\" id=\"wpforms-283-field_47\" class=\"wpforms-field-medium\" name=\"wpforms[fields][47]\" ><\/div><div id=\"wpforms-283-field_26-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_26\">Work Phone<\/label><input type=\"tel\" id=\"wpforms-283-field_26\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][26]\" aria-label=\"Work Phone\" ><\/div><div id=\"wpforms-283-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_12\">Do you rent or own? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-283-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"Homeowner\" >Homeowner<\/option><option value=\"Renter\" >Renter<\/option><\/select><\/div><div id=\"wpforms-283-field_28-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_28\">Landlord&#039;s Phone<\/label><input type=\"tel\" id=\"wpforms-283-field_28\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][28]\" aria-label=\"Landlord&#039;s Phone\" ><\/div><div id=\"wpforms-283-field_35-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"35\"><label class=\"wpforms-field-label\">Type of home you live in.<\/label><ul id=\"wpforms-283-field_35\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_35_1\" name=\"wpforms[fields][35][]\" value=\"House\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_35_1\">House<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_35_2\" name=\"wpforms[fields][35][]\" value=\"Apartment\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_35_2\">Apartment<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_35_3\" name=\"wpforms[fields][35][]\" value=\"Mobile Home\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_35_3\">Mobile Home<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_35_4\" name=\"wpforms[fields][35][]\" value=\"Duplex\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_35_4\">Duplex<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_35_6\" name=\"wpforms[fields][35][]\" value=\"Other\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_35_6\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-283-field_10-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_10\">Yard Size For Dog or Puppy <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-283-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" required=\"required\"><option value=\"No Yard\" >No Yard<\/option><option value=\"Small\" >Small<\/option><option value=\"Average\" >Average<\/option><option value=\"Large (acreage)\" >Large (acreage)<\/option><\/select><\/div><div id=\"wpforms-283-field_11-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_11\">Is your yard fenced?<\/label><select id=\"wpforms-283-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\"><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><option value=\"Partially\" >Partially<\/option><\/select><\/div><div id=\"wpforms-283-field_6-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_6\">Current Pet Owner? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-283-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required=\"required\"><option value=\"No\" >No<\/option><option value=\"Yes\" >Yes<\/option><\/select><\/div><div id=\"wpforms-283-field_46-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"46\"><label class=\"wpforms-field-label\">Animal Type You currenty own? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-283-field_46\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_46_1\" name=\"wpforms[fields][46][]\" value=\"Cats\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_46_1\">Cats<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_46_2\" name=\"wpforms[fields][46][]\" value=\"Kittens\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_46_2\">Kittens<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_46_3\" name=\"wpforms[fields][46][]\" value=\"Dogs\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_46_3\">Dogs<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_46_4\" name=\"wpforms[fields][46][]\" value=\"Puppies\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_46_4\">Puppies<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_46_5\" name=\"wpforms[fields][46][]\" value=\"Rabbits\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_46_5\">Rabbits<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_46_6\" name=\"wpforms[fields][46][]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_46_6\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-283-field_7-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"7\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_7\">How many of each? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-283-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required><\/div><div id=\"wpforms-283-field_13-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_13\">Do you have children in the home? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-283-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" required=\"required\"><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-283-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_30\">If yes, list the ages of children in the home<\/label><input type=\"text\" id=\"wpforms-283-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" ><\/div><div id=\"wpforms-283-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_14\">Please tell us who will care for your pet.<\/label><input type=\"text\" id=\"wpforms-283-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" ><\/div><div id=\"wpforms-283-field_15-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_15\">How many hours a day will your pet be aone at  home? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-283-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" required=\"required\"><option value=\"1-4\" >1-4<\/option><option value=\"5-9\" >5-9<\/option><option value=\"10-19\" >10-19<\/option><option value=\"20-24\" >20-24<\/option><\/select><\/div><div id=\"wpforms-283-field_17-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"17\"><h3 id=\"wpforms-283-field_17\">Veterinarian  Reference Details<\/h3><\/div><div id=\"wpforms-283-field_18-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_18\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-283-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required><\/div><div id=\"wpforms-283-field_19-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_19\">Email if known<\/label><input type=\"email\" id=\"wpforms-283-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-283-field_20-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_20\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-283-field_20\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][20]\" aria-label=\"Phone\" required><\/div><div id=\"wpforms-283-field_44-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"44\"><label class=\"wpforms-field-label\">Address  <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-283-field_44\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][44][address1]\" required><label for=\"wpforms-283-field_44\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-283-field_44-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][44][address2]\" ><label for=\"wpforms-283-field_44-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-283-field_44-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][44][city]\" required><label for=\"wpforms-283-field_44-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-283-field_44-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][44][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/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><\/select><label for=\"wpforms-283-field_44-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-283-field_44-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][44][postal]\" required><label for=\"wpforms-283-field_44-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-283-field_39-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"39\"><label class=\"wpforms-field-label\">Check those that you have read, and understand<\/label><ul id=\"wpforms-283-field_39\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_39_1\" name=\"wpforms[fields][39][]\" value=\"You are aware of the leash laws in your community. Keep your dog or puppy on heart worm preventative medicine as prescribed by your Veterinarian \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_39_1\">You are aware of the leash laws in your community. Keep your dog or puppy on heart worm preventative medicine as prescribed by your Veterinarian<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_39_2\" name=\"wpforms[fields][39][]\" value=\"I understand that I&#039;m responsible for, and have the financial means to cover medical expenses for my pet (s)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_39_2\">I understand that I'm responsible for, and have the financial means to cover medical expenses for my pet (s)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_39_3\" name=\"wpforms[fields][39][]\" value=\"Cats and Kittens are to be inside and will not be allowed outside without being om a leash.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_39_3\">Cats and Kittens are to be inside and will not be allowed outside without being om a leash.<\/label><\/li><\/ul><\/div><div id=\"wpforms-283-field_41-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"41\"><label class=\"wpforms-field-label\">An Adoption is a legal contract.<\/label><ul id=\"wpforms-283-field_41\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_41_1\" name=\"wpforms[fields][41][]\" value=\"If anything should change after the adoption and you can no longer keep your adopted pet, it must be returned to Animal Aid Humane Society. It cannot be given to another shelter or another person.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_41_1\">If anything should change after the adoption and you can no longer keep your adopted pet, it must be returned to Animal Aid Humane Society. It cannot be given to another shelter or another person.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_41_2\" name=\"wpforms[fields][41][]\" value=\"SPAY\/NEUTER POLICY: All adult pets adopted from Animal Aid Humane Society will already be spayed\/neutered at the time of adoption. If you wish to adopt a kitten under 5 months of age, we will give you a voucher to have the spay\/neuter performed at our cost and at a veterinarian of our choice as soon as the pet reaches 5 months of age. \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_41_2\">SPAY\/NEUTER POLICY: All adult pets adopted from Animal Aid Humane Society will already be spayed\/neutered at the time of adoption. If you wish to adopt a kitten under 5 months of age, we will give you a voucher to have the spay\/neuter performed at our cost and at a veterinarian of our choice as soon as the pet reaches 5 months of age.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-283-field_41_3\" name=\"wpforms[fields][41][]\" value=\"STATEMENT OF UNDERSTANDING : Will you adhere to this policy?  You agree that all statements you have made on this form are true. If it is found that any statements you have made on this form are not true, the  adopted animal can be confiscated by Anima Aid Humane Society.. You understand the information and references you have given may be verified by Animal Aid Humane Society to confirm landlord permission, veterinarian references, etc., and that this information will be held in confidence and used only by Animal Aid Humane Society.  You also understand that Animal Aid Humane Society maintains the right to refuse any adoptions in the best interest of the animal(s).\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-283-field_41_3\">STATEMENT OF UNDERSTANDING : Will you adhere to this policy?  You agree that all statements you have made on this form are true. If it is found that any statements you have made on this form are not true, the  adopted animal can be confiscated by Anima Aid Humane Society.. You understand the information and references you have given may be verified by Animal Aid Humane Society to confirm landlord permission, veterinarian references, etc., and that this information will be held in confidence and used only by Animal Aid Humane Society.  You also understand that Animal Aid Humane Society maintains the right to refuse any adoptions in the best interest of the animal(s).<\/label><\/li><\/ul><\/div><div id=\"wpforms-283-field_43-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-283-field_43\">Enter any questions you may have. <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-283-field_43\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][43]\" required><\/textarea><div class=\"wpforms-field-description\">Thank you for  completing this Pre-Adoption Application Form. The answers that you gave us will help us to determine\r\nwhat type of pet is right for you and your family as well as your lifestyle and will also help us to conclude what type of\r\nhome you will provide for one or more of our pets. \r\n\r\nADOPTION APPROVAL  If you have been selected to adopt this pet,\r\nsomeone from Animal Aid Humane Society will contact you by phone or email after receiving and reviewing your Preadoption\r\nApplication Form. Again we apologize for the length of this pre-adoption form. It is important that we cover all\r\nthe basic so to speak, so that you and the pet you choose will have a life long lovable relationship. Thank You for\r\nunderstanding<\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"283\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/pages\/314\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-283\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.molineanimalaid.org\/site\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.molineanimalaid.org\/site\/wp-content\/uploads\/2021\/09\/Not-Disposable.jpg\" alt=\"\" class=\"wp-image-325\" width=\"698\" height=\"278\"\/><\/figure><\/div>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" src=\"https:\/\/www.molineanimalaid.org\/site\/wp-content\/uploads\/2022\/05\/NOT-DISPOSABLE.jpg\" alt=\"\" class=\"wp-image-590\"\/><\/figure>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-314","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/pages\/314","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/comments?post=314"}],"version-history":[{"count":11,"href":"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/pages\/314\/revisions"}],"predecessor-version":[{"id":591,"href":"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/pages\/314\/revisions\/591"}],"wp:attachment":[{"href":"https:\/\/www.molineanimalaid.org\/site\/wp-json\/wp\/v2\/media?parent=314"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}