Adoption Application Step 1 of 3 - Personal Information 33% First Name*Last Name*Birthdate* Date Format: MM slash DD slash YYYY Phone*Email Address* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country GenderFemaleMaleNo PreferenceBreed Select All German Shepherd Dutch Shepherd Belgian Malinois Labrador Retriever Sporting Breed Other Select all that applyExperience with selected breed(s)Please describe your experience with each of the breeds selected above. 1. Do you live alone?YesNo2. Who else lives with you?List all people who live in your home. Ex, roommate, partner, spouse, child, etc. Type N/A if you live alone.3. Do you have children? If yes, give ages of all children.List all ages of children4. Does everyone in your household agree with this adoption?YesNo5. Does anyone in your household have allergies or asthma?YesNo6. Who will be the primary caretaker?*7. Are you prepared to care for this dog for the rest of its life?YesNo8. Who will care for your dog if you become ill or unable to do so?*Please list alternate caretaker name. Project K-9 Hero reserves the right of first refusal in the event you can no longer care for your dog.9. Why do you want to adopt a Police K-9 or Military Working Dog Hero?*10. Do you own your home or rent?rentown11. Do you have a yard?YesNo12. Is the yard fenced in?YesNo13. Do you have a pool?YesNo14. Where will your dog sleep?*15. Will you leave your dog alone during the day?YesNo16. Where will the dog be left alone?*17. How long will the dog be left alone?*18. How often will you exercise your dog?*19. Do you have enough time to play with your dog?YesNo20. Have you had a pet before?YesNo21. Did you ever have to surrender your pet to a pound or a shelter? If yes, why?YesNoList why you had to surrender your pet to the pound or shelter. If not applicable, enter N/A.*22. Do you currently have any other pets? If yes, list pet species, breed, age, gender and indicate whether spayed/ neutered if a dog.YesNoIf yes, list pet species, breed, age, gender and indicate whether spayed/ neutered if a dog.*23. Do you know a veterinarian you can go to? Please list vet contact info, name, address, phone number.YesNoPlease list vet contact info, name, address, phone number.*24. Will you stay up to date with vaccines?YesNo25. How often will you visit the veterinarian?*How often will you visit the vet?26. Are you able to cover all the vet expenses?YesNo27. Do you have a limit for vet visits? If yes, what is the limit?YesNoWhat is the limit? If no limit, enter N/A.*Tell us if there is a limit to your vet visits.28. How will you keep your dog’s teeth clean?*Tell us how you will care for your dog’s oral health.29. Will you take your dog to a groomer if the breed requires?YesNo30. Do you have a preferred gender for the dog? If Yes, tell us why.YesNoTell us why you want a specific gender.*31. What if your family situation changes? Who would care for your dog?*Tell us how your dog would be cared for if your family situation changes and you can no longer care for the dog. Project K-9 Hero reserves the right of first refusal in the event you can no longer care for your dog.32. Do you travel a lot?YesNo33. Who will care for your dog when you travel or will your dog travel with you?*Tell us who will care for your dog when you travel or will your dog travel with you?34. Under what circumstances would you give up your dog?*Tell us if there are any circumstances where you would you give up your dog.35. What will you do with the dog if you can’t keep it?*Tell us how your dog would be cared for if you can no longer care for the dog. Project K-9 Hero reserves the right of first refusal in the event you can no longer care for your dog.36. Some of our dogs come with a disability or with expensive medical costs. Are you mentally and financially prepared for that?YesNo37. Will you need additional info on dog care?YesNo38. Are you willing to have a video inspection of your home?YesNo39. How did you hear about our foundation?*Hold Harmless Waiver. Please note, adopting with Project K-9 Hero can consist of a long waiting period. Less than 10% of our dogs in the program require an adoption. Therefore we may not have dogs available at the time your application is submitted. When dogs do become available, they may not be a good fit for your particular home environment. We at Project K-9 Hero, take into consideration all factors that are on your questionnaire before we attempt to place a dog in your home. Your home must meet acceptable standards, which can vary by the type of dog to be placed. Project K-9 Hero aims to place a retired K-9 hero in the best home possible for that particular dog, but we cannot guarantee that you will receive a dog from our organization.* I affirm This iframe contains the logic required to handle Ajax powered Gravity Forms.