{"id":78,"date":"2024-05-24T13:37:23","date_gmt":"2024-05-24T13:37:23","guid":{"rendered":"http:\/\/klrnortheast.com\/?page_id=78"},"modified":"2025-01-18T04:05:26","modified_gmt":"2025-01-18T04:05:26","slug":"online-application-form","status":"publish","type":"page","link":"http:\/\/klrnortheast.com\/index.php\/online-application-form\/","title":{"rendered":"Online Application Form"},"content":{"rendered":"\n<td WIDTH=\"77%\" HEIGHT=\"460\">\n<table BORDER=0 >\n<tr>\n<td COLSPAN=\"2\"><font color=\"#FFFFFF\">Thank you for your interest in our\nfriends, please complete the form below to being the adoption process.<\/font>\n  <center>\n<p>\n<p>\n<p>\n\n  <\/center><div align=right>\n<p>&nbsp;<\/div>\n<\/td>\n<\/tr>\n<\/table>\n<form ACTION=\"http:\\\\www.kylabrescue.com\\thanksnew.php\" METHOD=\"POST\" onSubmit=\"return checkrequired(this)\">\n<table BORDER=2 >\n<tr>\n<td ALIGN=LEFT VALIGN=TOP COLSPAN=\"2\" BGCOLOR=\"#FFFFFF\"><b><font color=\"#003399\">Personal\nInformation:<\/font><\/b><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Date:<\/font><\/td>\n\n<td><input type=\"text\" name=\"date\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FF0000\">Required<\/font><font color=\"#FFFFFF\"> Applicant&#8217;s Name:<\/font><\/td>\n\n<td><input type=\"text\" name=\"requiredname_applicant\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Spouse&#8217;s Name:<\/font><\/td>\n\n<td><input type=\"text\" name=\"name_spouse\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FF0000\">Required<\/font><font color=\"#FFFFFF\"> Street Address:<\/font><\/td>\n\n<td><input type=\"text\" name=\"requiredstreet\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FF0000\">Required<\/font><font color=\"#FFFFFF\"> City:<\/font><\/td>\n\n<td><input type=\"text\" name=\"requiredcity\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FF0000\">Required<\/font><font color=\"#FFFFFF\"> State:<\/font><\/td>\n\n<td><input type=\"text\" name=\"requiredstate\" value=\"Kentucky\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FF0000\">Required <\/font><font color=\"#FFFFFF\">Zip Code:<\/font><\/td>\n\n<td><input type=\"text\" name=\"requiredzip_code\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FF0000\">Required<\/font><font color=\"#FFFFFF\"> Home Phone Number:<\/font><\/td>\n\n<td><input type=\"text\" name=\"requiredday_phone\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Evening Phone Number:<\/font><\/td>\n\n<td><input type=\"text\" name=\"evening_phone\" size=\"35\"><\/td>\n<\/tr>\n\t\t\t\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t\t\t\t<td align=RIGHT valign=TOP><font color=\"white\">Cell Phone Number 1:<\/font><\/td>\n\t\t\t\t\t\t\t\t\t\t\t<td><input type=\"text\" name=\"cell1\" size=\"35\"><\/td>\n\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t\t\t\t<td align=RIGHT valign=TOP><font color=\"white\">Cell Phone Number 2:<\/font><\/td>\n\t\t\t\t\t\t\t\t\t\t\t<td><input type=\"text\" name=\"cell2\" size=\"35\"><\/td>\n\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t\t<tr>\n\t\t\t\t\t\t\t\t\t\t\t<td align=RIGHT valign=TOP><font color=\"white\">Best Number to Be Reached At<\/font>:<\/td>\n\t\t\t\t\t\t\t\t\t\t\t<td><select name=\"best_number\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<option selected>Cell 1<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<option>Cell 2<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<option>Daytime<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<option>Evening<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/select><\/td>\n\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t\t<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Email:<\/font><\/td>\n\n<td><input type=\"text\" name=\"email\" size=\"35\"><\/td>\n<\/tr>\n\t\t\t\t\t\t\t\t\t\t<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Occupation of Applicant:<\/font><\/td>\n\n<td><input type=\"text\" name=\"occupation_applicant\" size=\"35\"><\/td>\n<\/tr>\n\t\t\t\t\t\t\t\t\t\t<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Employer:<\/font><\/td>\n\n<td><input type=\"text\" name=\"employer_applicant\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Occupation of Spouse:<\/font><\/td>\n\n<td><input type=\"text\" name=\"occupation_spouse\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Employer:<\/font><\/td>\n\n<td><input type=\"text\" name=\"employer_spouse\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td COLSPAN=\"2\" BGCOLOR=\"#FFFFFF\"><b><font color=\"#003399\">Your Family\nand Pets<\/font><\/b><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">How many adults in the\nhome?<\/font><\/td>\n\n<td><input type=\"text\" name=\"adults_home\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">How many children in the\nhome?<\/font><\/td>\n\n<td><input type=\"text\" name=\"children_home\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Ages of children:<\/font><\/td>\n\n<td><input type=\"text\" name=\"children_ages\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Please describe what type\nof housing you have:<\/font><\/td>\n\n<td VALIGN=TOP><select name=\"housing\"><option selected>house<\/option><option>townhouse\/condominium<\/option><option>duplex<\/option><option>trailer\/mobile\nhome<\/option><option>apartment<\/option><option>other<\/option><\/select><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Do you own or rent your\nhome?<\/font><\/td>\n\n<td><input type=\"text\" name=\"own_or_rent_home\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Fenced in yard?<\/font><\/td>\n\n<td><input type=\"radio\" name=\"Fenced_in_yard\" value=\"yes\"><font color=\"#FFFFFF\">yes&nbsp;<input type=\"radio\" name=\"Fenced_in_yard\" value=\"no\">no<\/font><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Height and type of fence:<\/font><\/td>\n\n<td><input type=\"text\" name=\"fence\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">List current pets, including\nage and sex:<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"current_pets\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">List former pets that\nyou have had in the last 5 years and please explain what happened to them:<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"former_pets\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td COLSPAN=\"2\" BGCOLOR=\"#FFFFFF\"><b><font color=\"#003399\">Veterinarian\nInformation:<\/font><\/b><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Do you have a Veterinarian?\nIf so, please list the name:<\/font><\/td>\n\n<td><input type=\"text\" name=\"vet_name\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Your Veterinarian&#8217;s Phone\nNumber:<\/font><\/td>\n\n<td><input type=\"text\" name=\"vet_phone\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Have you used this vet\nin the past?<\/font><\/td>\n\n<td><input type=\"text\" name=\"used_this_vet_before\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td COLSPAN=\"2\" BGCOLOR=\"#FFFFFF\"><b><font color=\"#003399\">References:<\/font><\/b><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Reference #1 Name:<\/font><\/td>\n\n<td><input type=\"text\" name=\"reference_1_name\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Reference #1 Phone Number:<\/font><\/td>\n\n<td><input type=\"text\" name=\"reference_1_phone\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">[Non Family Member] Reference\n#2 Name:<\/font><\/td>\n\n<td><input type=\"text\" name=\"non_family_reference_2_name\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Reference #2 Phone Number:<\/font><\/td>\n\n<td><input type=\"text\" name=\"non_family_reference_2_phone\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td COLSPAN=\"2\" BGCOLOR=\"#FFFFFF\"><b><font color=\"#003399\">Your interest\nin dogs:<\/font><\/b><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Why do you want a dog?<\/font><\/td>\n\n<td><input type=\"checkbox\" name=\"want_lab_for\" value=\"companion\"><font color=\"#FFFFFF\">Companion<\/font>\n<br><input type=\"checkbox\" name=\"want_lab_for\" value=\"huntdog\"><font color=\"#FFFFFF\">Hunting\nDog<\/font>\n<br><input type=\"checkbox\" name=\"want_lab_for\" value=\"childcompanion\"><font color=\"#FFFFFF\">Child&#8217;s\nCompanion<\/font>\n<br><input type=\"checkbox\" name=\"want_lab_for\" value=\"other\"><font color=\"#FFFFFF\">Other:&nbsp;<\/font><input type=\"text\" name=\"other_described\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Please explain the type\nof friend&nbsp;<\/font>\n<br><font color=\"#FFFFFF\">that would best fit into your lifestyle:<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"type_of_lab_for_applicant_lifestyle\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Explain your interest\nin rescue dogs, if any:<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"why_rescue\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Is there anyone at home\nwith pet allergies?<\/font><\/td>\n\n<td><input type=\"text\" name=\"allergies_in_home\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td COLSPAN=\"2\" BGCOLOR=\"#FFFFFF\"><b><font color=\"#003399\">Care and Training<\/font><\/b><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Who will be responsible\nfor the care of the dog?<\/font><\/td>\n\n<td><input type=\"text\" name=\"who_responsible_for_lab\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Where will the dog be\nkept during the day?<\/font><\/td>\n\n<td><input type=\"text\" name=\"where_lab_kept_daytime\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Where will the dog be\nkept at night?<\/font><\/td>\n\n<td><input type=\"text\" name=\"where_lab_kept_nighttime\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Are you familiar with\nthe use of a crate to train&nbsp;<\/font>\n<br><font color=\"#FFFFFF\">and\/or confine the dog in your absence?<\/font><\/td>\n\n<td><input type=\"text\" name=\"familiar_with_crate\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Will the dog have the\nrun of the house?<\/font><\/td>\n\n<td><input type=\"text\" name=\"run_of_house\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Will the dog be tied outside\nor live in the yard?<\/font><\/td>\n\n<td><input type=\"text\" name=\"tied_live_outside\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Do you own a kennel?<\/font><\/td>\n\n<td><input type=\"radio\" name=\"own_kennel\" value=\"yes\"><font color=\"#FFFFFF\">yes<input type=\"radio\" name=\"own_kennel\" value=\"no\">no<\/font><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Kennel description:<\/font><\/td>\n\n<td><input type=\"text\" name=\"if_kennel_description\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Describe your dog training\nexperience:<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"dog_training_experience\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">What books have you read\non training dogs?<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"dog_training_books\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Do you have plans for\nobedience training?<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"obedience_training_plans\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">What type of discipline\nwill you use when training?<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"how_discipline\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Activities you plan to\nshare with your dog:<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"activities_with_lab\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">What will you do with\nyour dog&nbsp;<\/font>\n<br><font color=\"#FFFFFF\">when you go on vacation?<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"when_on_vacation\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">If you move, what will\nyou do with your dog?<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"if_move\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Are you willing to care\nfor this dog for 10 years or more?<\/font><\/td>\n\n<td><input type=\"radio\" name=\"care_for_10yr\" value=\"yes\"><font color=\"#FFFFFF\">Yes<\/font>\n<br><input type=\"radio\" name=\"care_for_10yr\" value=\"no\"><font color=\"#FFFFFF\">No<\/font><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">We require that all dogs\nbe spayed\/neutered prior to adoption; do you have any questions about this\npolicy?<\/font><\/td>\n\n<td><textarea cols=35 rows=7 name=\"spay_neuter_questions\"><\/textarea><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">If you are unable to care\nfor your dog in the future,<\/font>\n<br><font color=\"#FFFFFF\">who will accept responsibility for its care?<\/font><\/td>\n\n<td><input type=\"text\" name=\"if_unable_to_care\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">In what type of vehicle\nwill you transport your dog?&nbsp;<\/font><\/td>\n\n<td><input type=\"text\" name=\"vehicle_type\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">We try to follow up on\nthe welfare of our adopted dogs.<\/font>\n<br><font color=\"#FFFFFF\">Can we visit or call upon you after the adoption?<\/font><\/td>\n\n<td><input type=\"text\" name=\"can_we_visit_or_call\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td COLSPAN=\"2\" BGCOLOR=\"#FFFFFF\"><b><font color=\"#003399\">Dog Preferences:<\/font><\/b><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Gender Preference:<\/font><\/td>\n\n<td><select name=\"gender_preference\"><option value=\"no_choice\">-please\nchoose-<\/option><option value=\"male\">male (neutered)<\/option><option value=\"female\">female\n(spayed)<\/option><option value=\"either\">either<\/option><\/select><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=CENTER COLSPAN=\"2\"><font color=\"#FFFFFF\"><font size=-1>(All dogs\nare spayed\/neutered prior to adoption.)<\/font><\/font><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">What color dog are you\ninterested in?<\/font><\/td>\n\n<td><select name=\"color_preference\"><option value=\"no_choice\">-please choose-<\/option><option value=\"black\">black<\/option><option value=\"yellow\">yellow<\/option><option value=\"chocolate\">chocolate<\/option><option value=\"nocolorpref\">no\npreference<\/option><\/select><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Please tell us the age\nof dog that interests you:<\/font>\n<p><font color=\"#FFFFFF\">(<font size=-1>Dogs have a longer puppyhood due\nto their outgoing natures and one can expect puppylike behavior until about\n2 years old<\/font>)<\/font><\/td>\n\n<td><i><font color=\"#FFFFFF\">check all that apply&nbsp;<\/font><\/i>\n<br><input type=\"checkbox\" name=\"age_preference\" value=\"<6mo\"><font color=\"#FFFFFF\">less\nthan 6 months old<\/font>\n<br><input type=\"checkbox\" name=\"age_preference\" value=\"6-12mo\"><font color=\"#FFFFFF\">6\nto 12 months old<\/font>\n<br><input type=\"checkbox\" name=\"age_preference\" value=\"12-18mo\"><font color=\"#FFFFFF\">12\nto 18 months old<\/font>\n<br><input type=\"checkbox\" name=\"age_preference\" value=\"2-3yr\"><font color=\"#FFFFFF\">2\nto 3 years old<\/font>\n<br><input type=\"checkbox\" name=\"age_preference\" value=\"4yr_or_>&#8220;><font color=\"#FFFFFF\">4\nyears old or more<\/font>\n<br><input type=\"checkbox\" name=\"age_preference\" value=\"no_preference\"><font color=\"#FFFFFF\">no\npreference<\/font><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Temperament:<\/font><\/td>\n\n<td><select name=\"temperament\"><option value=\"no_choice\">-please choose-<\/option><option value=\"active\">active<\/option><option value=\"moderately_active\">moderately\nactive<\/option><option value=\"gentle\">gentle\/not active<\/option><\/select><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Do you have any special\nneeds or wants?<\/font><\/td>\n\n<td><input type=\"text\" name=\"any_special_needs\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP><font color=\"#FFFFFF\">Dogs listed on our site\nthat you are interested in:<\/font><\/td>\n\n<td><input type=\"text\" name=\"names_of_dogs_interested_in\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n<td ALIGN=RIGHT VALIGN=TOP HEIGHT=\"41\"><font color=\"#FFFFFF\">How did you\nhear about KLR?<\/font><\/td>\n\n<td HEIGHT=\"41\"><input type=\"text\" name=\"how_hear_about_CKLR\" size=\"35\"><\/td>\n<\/tr>\n\n<tr>\n  <td COLSPAN=\"2\" ALIGN=CENTER bgcolor=\"#FFFFFF\"><div align=\"left\"><font color=\"#003399\"><strong><\/strong><\/font><\/div><\/td>\n<\/tr>\n<tr>\n  <td ALIGN=Left COLSPAN=\"2\"><\/td>\n<\/tr>\n\n<tr>\n  <td ALIGN=CENTER COLSPAN=\"2\"><\/tr>\n\t<tr>\t<\/tr>\n\t<tr><\/tr>\n    <tr>\n     \n<\/tr>\n<tr>\n<td ALIGN=CENTER COLSPAN=\"2\"><input TYPE=\"submit\" VALUE=\"Send Application\"><input type=\"reset\" value=\" Clear-Form\"><\/td>\n<\/tr>\n<\/table>\n<\/form>\n<center>\n<p>&nbsp;\n<\/center><\/td>\n\n<td WIDTH=\"3%\" HEIGHT=\"460\">&nbsp;<\/td>\n<\/tr>\n\n<tr ALIGN=LEFT VALIGN=TOP>\n<td WIDTH=\"17%\" HEIGHT=\"2\">&nbsp;<\/td>\n\t\t\t\t\t\t\t<td WIDTH=\"3%\" HEIGHT=\"2\"><img SRC=\"file:\/\/\/Macintosh 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Northeast<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/klrnortheast.com\/index.php\/online-application-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Online Application Form - KLR Northeast\" \/>\n<meta property=\"og:description\" content=\"Thank you for your interest in our friends, please complete the form below to being the adoption process. &nbsp; Personal Information: Date: Required Applicant&#8217;s Name: Spouse&#8217;s Name: Required Street Address: Required City: Required State: Required Zip Code: Required Home Phone Number: Evening Phone Number: Cell Phone Number 1: Cell Phone Number 2: Best Number to [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"http:\/\/klrnortheast.com\/index.php\/online-application-form\/\" \/>\n<meta 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