{"id":919,"date":"2017-04-20T21:15:48","date_gmt":"2017-04-21T03:15:48","guid":{"rendered":"http:\/\/www-new.malamuterescue.org\/?page_id=919"},"modified":"2020-11-15T10:55:56","modified_gmt":"2020-11-15T17:55:56","slug":"application-form","status":"publish","type":"page","link":"https:\/\/www.malamuterescue.org\/index.php\/application-form\/","title":{"rendered":"Application Form"},"content":{"rendered":"<p><script>\n  var nReload = 5;\n  function NewVerifyImage() {\n    if (nReload <= 2)\n      if (nReload <= 0) {\n            alert(\"Sorry, too many reloads.\");\n            return;\n       }\n        else\n          alert(\"Only \" + nReload + \" more reloads are allowed\");\n    nReload--;\n\/\/\n\/\/ This code now works in both IE and FireFox\n\/\/\n    var e_img;\n    e_img = document.getElementById(\"vimg\");\n\/\/\n\/\/ FireFox attempts to \"optimize\" by not reloading\n\/\/ the image if the URL value doesn't actually change.\n\/\/ So, we make it change by adding a different\n\/\/ count parameter for each reload.\n\/\/\n    if (e_img)\n      e_img.setAttribute(\"src\",e_img.src+'?count='+nReload);\n    return false;\n}\n<\/script><\/p>\n<table style=\"border: 0px solid transparent; width: 1020px;\">\n<caption>\n<h2 class=\"black\" style=\"text-align: left;\">Thank you for your interest in Alaskan malamute rescue!<\/h2>\n<\/caption>\n<tbody>\n<tr>\n<td style=\"width: 100px; height: 98px;\" rowspan=\"4\"><img decoding=\"async\" style=\"margin: 2px; text-align: left; vertical-align: top; width: 100px; height: 98px;\" src=\"\/wp-content\/uploads\/2017\/04\/stop.png\"><\/td>\n<td colspan=\"6\"><strong style=\"font-size: 18px;\">Complete this application <i>only<\/i> if you reside in one of the following states:<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Alabama<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Alaska<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Arizona<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Arkansas<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Georgia<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Iowa<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Kansas<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\"><span style=\"font-size: medium;\">Kentucky<\/span><\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Minnesota<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Mississippi<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Missouri<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Nebraska<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">North Dakota<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Ohio<\/span><\/td>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Oklahoma<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 170px; text-align: left; vertical-align: middle; height: 12px;\"><img decoding=\"async\" style=\"text-align: left; vertical-align: middle; width: 18px; height: 12px;\" src=\"\/wp-content\/uploads\/2017\/04\/bulletsphere.jpg\" alt=\"bullet\">&nbsp;<span style=\"font-size: medium;\">Tennessee<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"width: 800px;\">If you live in a state <b>not<\/b> listed above, that means that there is an AMAL affiliated rescue contact in your area. Please find your local contact <a href=\"\/index.php\/rescue-affiliates\/\">here<\/a>.<\/p>\n<p>Please fill out the application completely. Questions with required responses are colored <span style=\"color: red;\">red<\/span>. The application will not be accepted if answers to those questions are omitted.<\/p>\n<hr style=\"width: 800px;\">\n<div style=\"text-align: left; width: 800px;\">\n<form action=\"\/wp-content\/adoption_app.php\" method=\"POST\">\n<input name=\"ftd6yf\" type=\"hidden\" value=\"3nzfh6\"><br \/>\n<input name=\"w67dwr\" type=\"hidden\" value=\"\"><\/p>\n<h3>Personal Information<\/h3>\n<p><label class=\"red\">First Name:<\/label><input maxlength=\"50\" name=\"firstname\" size=\"20\" type=\"text\" style=\"width: 120px;\"><label>MI:<\/label><input maxlength=\"2\" name=\"mi\" size=\"2\" type=\"text\" style=\"width: 15px;\"><label class=\"red\">Last Name:<\/label><input maxlength=\"50\" name=\"lastname\" size=\"20\" type=\"text\" style=\"width: 120px;\"><label class=\"red\">email:<\/label><input maxlength=\"100\" name=\"email\" size=\"25\" type=\"text\" style=\"width: 150px;\"><\/p>\n<p><label class=\"red\">Street Address1:<\/label><input maxlength=\"100\" name=\"address1\" size=\"20\" type=\"text\" style=\"width: 150px;\"><label class=\"red\">City:<\/label><input maxlength=\"100\" name=\"city\" size=\"20\" type=\"text\" style=\"width: 150px;\"><label class=\"red\">Verify e-mail:<\/label><input maxlength=\"100\" name=\"verifyemail\" size=\"25\" type=\"text\" style=\"width: 150px;\"><\/p>\n<p><label>Street Address2:<\/label><input maxlength=\"100\" name=\"address2\" size=\"20\" type=\"text\" style=\"width: 150px;\"><label class=\"red\">Zip Code:<\/label><input maxlength=\"100\" name=\"zip\" size=\"20\" type=\"text\" style=\"width: 65px;\"><label class=\"red\">State:<\/label><select name=\"state\" size=\"3\"><option>AK<\/option><option>AL<\/option><option>AR<\/option><option>AZ<\/option><option>GA<\/option><option>IA<\/option><option>KS<\/option><option>KY<\/option><option>MN<\/option><option>MS<\/option><option>MO<\/option><option>NE<\/option><option>ND<\/option><option>OH<\/option><option>OK<\/option><option>TN<\/option><\/select><\/p>\n<p><label class=\"red\">Phone (Only one needed)&nbsp;&nbsp;&nbsp;<span style=\"color: black;\">Home:<\/span><\/label><input maxlength=\"20\" name=\"homephone\" size=\"12\" type=\"text\" style=\"width: 80px;\"><label>Work:<\/label><input maxlength=\"20\" name=\"workphone\" size=\"12\" type=\"text\" style=\"width: 80px;\"><label>Cell:<\/label><input maxlength=\"20\" name=\"cellphone\" size=\"12\" type=\"text\" style=\"width: 80px;\"><\/p>\n<p><label class=\"red\">Near what large city are you located?<\/label><input maxlength=\"100\" name=\"largecity\" size=\"20\" type=\"text\" style=\"width: 150px;\"><label class=\"red\">Do you<\/label><input name=\"ownorrent\" type=\"radio\" value=\"own\" style=\"width: 15px\"><label class=\"red\">own&nbsp;or<label><input name=\"ownorrent\" type=\"radio\" value=\"rent\" style=\"width: 15px\"><label class=\"red\">rent?<\/label><\/label><\/label><\/p>\n<p><label class=\"red\">If you don't own your residence please provide your landlord's name and phone number:<\/label><textarea cols=\"70\" name=\"landlord\" rows=\"2\" style=\"width: 200px;\"><\/textarea><\/p>\n<hr>\n<h3>Household Information<\/h3>\n<p><label>Spouse\/Partner Name:<\/label><input maxlength=\"80\" name=\"spousename\" size=\"20\" type=\"text\" style=\"width: 120px;\"><label class=\"red\">Ages of Adults in Home:<\/label><input maxlength=\"30\" name=\"adultages\" size=\"20\" type=\"text\" style=\"width: 40px;\"><label>Ages of Children in Home or Visiting:<\/label><input maxlength=\"30\" name=\"childages\" size=\"10\" type=\"text\" stylekk=\"width: 40px;\"><\/p>\n<p><label class=\"red\">Is everyone in the household in agreement about adopting a malamute:<\/label><input name=\"allagree\" type=\"radio\" value=\"yes\" style=\"width: 15px;\"><label class=\"red\">yes or <\/label><input name=\"allagree\" type=\"radio\" value=\"no\" style=\"width: 15px;\"><label class=\"red\">no?<\/label><\/p>\n<p><label>Who else (children, grandchildren, neighbors, nephews, nieces, etc.) will have contact with the dog?<\/label><input maxlength=\"150\" name=\"whoelse\" size=\"70\" type=\"text\" style=\"width: 600px;\"><\/p>\n<hr>\n<h3>Malamute Experience<\/h3>\n<p><label class=\"red\">Have you ever owned an Alaskan malamute before:<\/label><input name=\"everown\" type=\"radio\" value=\"yes\" style=\"width: 15px;\"><label class=\"red\">yes or <\/label><input name=\"everown\" type=\"radio\" value=\"no\" style=\"width: 15px;\"><label class=\"red\">no?<\/label><\/p>\n<p><label>Which do you prefer:<\/label><input name=\"preference\" type=\"radio\" value=\"male\" style=\"width: 20px;\"><label>male,<\/label><input name=\"preference\" type=\"radio\" value=\"female\" style=\"width: 20px;\"><label>female or<\/label><input name=\"preference\" type=\"radio\" value=\"either\" style=\"width: 20px;\"><label>either?<\/label><label>Will you consider a malamute mix:<\/label><input name=\"considermix\" type=\"radio\" value=\"yes\" style=\"width: 15px;\"><label>yes or <\/label><input name=\"considermix\" type=\"radio\" value=\"no\" style=\"width: 15px;\"><label>no?<\/label><\/p>\n<hr>\n<h3>Malamute Living Environment<\/h3>\n<p><label class=\"red\">How long will the dog be left alone, on average each day?<\/label><input maxlength=\"20\" name=\"howlongalone\" size=\"10\" type=\"text\" style=\"width: 150px;\"><\/p>\n<p><label class=\"red\">Where will the dog stay during the day?<\/label><input maxlength=\"150\" name=\"wherestay\" size=\"70\" type=\"text\" style=\"width: 150px;\"><\/p>\n<p><label class=\"red\">Where will the dog sleep at night?<\/label><input maxlength=\"150\" name=\"wheresleep\" size=\"70\" type=\"text\" style=\"width: 150px;\"><\/p>\n<p><label class=\"red\">Do you have a completely fenced in yard:<\/label><input name=\"fencedyard\" type=\"radio\" value=\"yes\" style=\"width: 15px;\"><label class=\"red\">yes or<\/label><input name=\"fencedyard\" type=\"radio\" value=\"no\" style=\"width: 15px;\"><label class=\"red\">no?<\/label><label>Are you familar with crate training:<\/label><input name=\"cratetrain\" type=\"radio\" value=\"yes\" style=\"width: 15px;\"><label>yes or<\/label><input name=\"cratetrain\" type=\"radio\" value=\"no\" style=\"width: 15px;\"><label>no?<\/label><\/p>\n<p><label class=\"red\">Approximate size of fenced area:<\/label><input maxlength=\"10\" name=\"fencexdim\" size=\"5\" type=\"text\" style=\"width: 25px;\"><label class=\"red\">ft. by<\/label><input maxlength=\"10\" name=\"fenceydim\" size=\"5\" type=\"text\" style=\"width: 25px;\"><label class=\"red\">ft.<\/label><label class=\"red\">Fence Height:<\/label><input maxlength=\"10\" name=\"fenceheight\" size=\"5\" type=\"text\" style=\"width: 25px;\"><label class=\"red\">ft.<\/label><\/p>\n<p><label class=\"red\">If you do not have a fenced yard, how do you plan to exercise and contain a malamute?<\/label><textarea cols=\"80\" name=\"howtocontain\" rows=\"2\" style=\"width: 600px;\"><\/textarea><\/p>\n<p><label class=\"red\">Do you understand that a malamute can never be off-leash in an unsecured area:<\/label><input name=\"notofflead\" type=\"radio\" value=\"yes\" style=\"width: 15px;\"><label class=\"red\">yes or<\/label><input name=\"notofflead\" type=\"radio\" value=\"no\" style=\"width: 15px;\"><label class=\"red\">no?<\/label><\/p>\n<p><label class=\"red\">Do you plan to use a chain, tether, or overhead runner to contain a malamute:<\/label><input name=\"tethered\" type=\"radio\" value=\"yes\" style=\"width: 15px;\"><label class=\"red\">yes or<\/label><input name=\"tethered\" type=\"radio\" value=\"no\" style=\"width: 15px;\"><label class=\"red\">no?<\/label><\/p>\n<p><label>Do you intend to be a<\/label><input name=\"singledog\" type=\"radio\" value=\"single\" style=\"width: 30px;\"><label>Single Dog or<\/label><input name=\"singledog\" type=\"radio\" value=\"multi\" style=\"width: 30px;\"><label>Multi Dog Home?<\/label><\/p>\n<hr>\n<h3>Pet History<\/h3>\n<p><label class=\"red\">Please tell us about your current pets: breed, sex, age, spayed\/neutered or put \"none\" if you don't currently have pets:<\/label><textarea cols=\"80\" name=\"currentpets\" rows=\"4\" style=\"width: 600px;\"><\/textarea><\/p>\n<p><label class=\"red\">Please tell us about all the pets you\u2019ve owned in the past, how long you had them, and what happened to them:<\/label><textarea cols=\"80\" name=\"pastpets\" rows=\"4\" style=\"width: 600px;\"><\/textarea><\/p>\n<hr>\n<h3>Home Check, References &amp; Other Considerations<\/h3>\n<p><label class=\"red\">Are you willing to allow a volunteer to visit your home by appointment:<\/label><input name=\"appointment\" type=\"radio\" value=\"yes\" style=\"width: 15px;\"><label class=\"red\">yes or<\/label><input name=\"appointment\" type=\"radio\" value=\"no\" style=\"width: 15px;\"><label class=\"red\">no?<\/label><\/p>\n<p><label class=\"red\"><b>Please list the contact information of current and\/or prior veterinarians for all pets owned in the last 10 years.<\/b><br \/>\nPlease note: we must be able to verify vaccines, spay\/neuter, and heartworm preventive purchases. If you purchase your medications somewhere other than from your veterinarian, please indicate where.<\/label><textarea cols=\"80\" name=\"vetinfo\" rows=\"4\" style=\"width: 600px;\"><\/textarea><\/p>\n<p><label>Please take a moment and add any other information you would like us to consider:<\/label><textarea cols=\"80\" name=\"otherinfo\" rows=\"4\" style=\"width: 600px;\"><\/textarea><\/p>\n<hr>\n<p><b>By submitting this application, you declare that the above is true to the best of your knowledge and ability. You authorize the veterinarian listed above to release information on the health care of your current and\/or prior pets. You further understand that completion of this application does not guarantee that you will be able to adopt.<\/b><\/p>\n<p>Enter the characters you see in the image. If you cannot read the image, click for a new one.<br \/>\n<input name=\"compare\" type=\"hidden\" value=\"1\"><input maxlength=\"6\" name=\"imgverify\" type=\"text\" style=\"width: 60px;\"><img decoding=\"async\" id=\"vimg\" src=\"\/wp-content\/captcha.php\" alt=\"CAPTCHA\" style=\"vertical-align:middle;height:40px;\" \/><button onclick=\"NewVerifyImage(); return false;\"><b>New<br \/>\nImage<\/b><\/button><\/p>\n<p><button type=\"submit\" value=\"Submit\"><b>Submit<\/b><\/button><a href=\"\/index.php\/application-form\/\" class=\"button\">Reset<\/a><\/p>\n<\/form>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>Thank you for your interest in Alaskan malamute rescue! Complete this application only if you reside in one of the following states: &nbsp;Alabama &nbsp;Alaska &nbsp;Arizona &nbsp;Arkansas &nbsp;Georgia &nbsp;Iowa &nbsp;Kansas &nbsp;Kentucky &nbsp;Minnesota &nbsp;Mississippi &nbsp;Missouri &nbsp;Nebraska &nbsp;North <a class=\"mh-excerpt-more\" href=\"https:\/\/www.malamuterescue.org\/index.php\/application-form\/\" title=\"Application Form\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":18,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-full.php","meta":{"footnotes":""},"class_list":["post-919","page","type-page","status-publish"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.malamuterescue.org\/index.php\/wp-json\/wp\/v2\/pages\/919","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.malamuterescue.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.malamuterescue.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.malamuterescue.org\/index.php\/wp-json\/wp\/v2\/users\/18"}],"replies":[{"embeddable":true,"href":"https:\/\/www.malamuterescue.org\/index.php\/wp-json\/wp\/v2\/comments?post=919"}],"version-history":[{"count":261,"href":"https:\/\/www.malamuterescue.org\/index.php\/wp-json\/wp\/v2\/pages\/919\/revisions"}],"predecessor-version":[{"id":3468,"href":"https:\/\/www.malamuterescue.org\/index.php\/wp-json\/wp\/v2\/pages\/919\/revisions\/3468"}],"wp:attachment":[{"href":"https:\/\/www.malamuterescue.org\/index.php\/wp-json\/wp\/v2\/media?parent=919"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}