/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
* Includes a Form with javascript
* @param {Object} formId
* @param {Object} initialHeight
* @param {Object} iframeCode
*/
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
this.formId = formId;
this.initialHeight = initialHeight;
this.iframeCode = iframeCode;
this.frame = null;
this.timeInterval= 200;
this.appendTo = appendTo || false;
// initialize function for object
this.init = function(){
this.createFrame();
this.addFrameContent(this.iframeCode);
};
// Create the frame
this.createFrame = function(){
var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\">";
if(this.appendTo === false){
document.write(htmlCode);
}else{
var tmp = document.createElement('div');
tmp.innerHTML = htmlCode;
var a = this.appendTo;
document.getElementById(a).appendChild(tmp.firstChild);
}
// also get the frame for future use.
this.frame = document.getElementById(this.formId);
// set the time on the on load event of the frame
this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
};
// add event function for different browsers
this.addEvent = function( obj, type, fn ) {
if ( obj.attachEvent ) {
obj["e"+type+fn] = fn;
obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
obj.attachEvent( "on"+type, obj[type+fn] );
}
else{
obj.addEventListener( type, fn, false );
}
};
this.addFrameContent = function (string){
string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"><'+'div id="recaptcha_div"><'+'/div>'+
'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
' }<'+'/script>');
string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
frameDocument.document.open();
frameDocument.document.write(string);
setTimeout( function(){
frameDocument.document.close();
try{
if('JotFormFrameLoaded' in window){
JotFormFrameLoaded();
}
}catch(e){}
},200);
};
this.setTimer = function(){
var self = this;
this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
};
this.changeHeight = function (){
var actualHeight = this.getBodyHeight();
var currentHeight = this.getViewPortHeight();
if(actualHeight === undefined){
this.frame.style.height = "100%";
if(!this.frame.style.minHeight){
this.frame.style.minHeight = "300px";
}
}else if (Math.abs(actualHeight - currentHeight) > 18){
this.frame.style.height = (actualHeight)+"px";
}
this.setTimer();
};
this.bindMethod = function(method, scope) {
return function() {
method.apply(scope,arguments);
};
};
this.getBodyHeight = function (){
var height;
var scrollHeight;
var offsetHeight;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.document.height){
height = this.frame.contentWindow.document.height;
//Emre: to prevent "iframe height" problem (61059)
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
} else if (this.frame.contentWindow.document.body){
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
if (scrollHeight && offsetHeight){
height = Math.max(scrollHeight, offsetHeight);
}
}
}catch(e){ }
return height;
};
this.getViewPortHeight = function(){
var height = 0;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.window.innerHeight)
{
height = this.frame.contentWindow.window.innerHeight - 18;
}
else if ((this.frame.contentWindow.document.documentElement) &&
(this.frame.contentWindow.document.documentElement.clientHeight))
{
height = this.frame.contentWindow.document.documentElement.clientHeight;
}
else if ((this.frame.contentWindow.document.body) &&
(this.frame.contentWindow.document.body.clientHeight))
{
height = this.frame.contentWindow.document.body.clientHeight;
}
}catch(e){ }
return height;
};
this.init();
}
FrameBuilder.get = [];
var i82171856201 = new FrameBuilder("82171856201", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2341\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"http:\/\/www.jotform.com\/css\/styles\/baby_blue.css\" \/>\n<style type=\"text\/css\">\n .form-label{\n width:150px !important;\n }\n .form-label-left{\n width:150px !important;\n }\n .form-line{\n padding:5px;\n }\n .form-label-right{\n width:150px !important;\n }\n body, html{\n margin:0;\n padding:0;\n background:#D7E9F3;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:0px;\n width:690px;\n background:#D7E9F3;\n color:#394F5F !important;\n font-family:Verdana;\n font-size:11px;\n }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2341\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n JotForm.jsForm = true;\n\n JotForm.init(function(){\n JotForm.setCalendar(\"18\");\n JotForm.description('input_21', 'ex. 1112225555');\n JotForm.description('input_22', 'ex. 1112225555');\n JotForm.description('input_111', 'ex. 1112225555');\n JotForm.description('input_114', 'ex. 1112225555');\n JotForm.description('input_120', 'ex. 1112225555');\n JotForm.description('input_124', 'ex. 1112225555');\n JotForm.initCaptcha('input_271');\n });\n\n clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" name=\"form_82171856201\" id=\"82171856201\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"82171856201\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li id=\"cid_289\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_289\" class=\"form-header\">\n IMPORTANT ADOPTION POINTS\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_12\">\n <div id=\"cid_12\" class=\"form-input-wide\">\n <div id=\"text_12\" class=\"form-html\">\n <font style=\"font-family: Verdana; color: rgb(0, 0, 102);\" size=\"2\">\n By submitting this application, you are making a formal request to adopt a dog from New England Border Collie Rescue, Inc. (NEBCR)\n <\/font>\n <ul style=\"font-family: Verdana; color: rgb(0, 0, 102);\">\n <li>\n <font size=\"2\">\n All applicants are thoroughly screened and must meet certain qualifications for approval.\n <\/font>\n <\/li>\n <\/ul>\n <font size=\"2\">\n <br>\n <\/font>\n <ul style=\"font-family: Verdana; color: rgb(0, 0, 102);\">\n <li>\n <font size=\"2\">\n Compatible Border Collies may not immediately be available. Your patience is appreciated!\n <\/font>\n <\/li>\n <\/ul>\n <br>\n <ul style=\"font-family: Verdana; color: rgb(0, 0, 102);\">\n <li>\n <font size=\"2\">\n A donation to New England Border Collie Rescue, Inc. is required to adopt a Border Collie. Please refer back to\n <a href=\"http:\/\/nebcr.org\/Adopting_a_Border_Collie.html\">Adopting a Border Collie<\/a>\n page for more information.\n <\/font>\n <\/li>\n <\/ul>\n <font size=\"2\">\n <br>\n <\/font>\n <ul style=\"font-family: Verdana; color: rgb(0, 0, 102);\">\n <li>\n <font size=\"2\">\n We only adopt to homes in the Northeast.\n <\/font>\n <\/li>\n <\/ul>\n <font size=\"2\">\n <br>\n <\/font>\n <ul style=\"font-family: Verdana; color: rgb(0, 0, 102);\">\n <li>\n <font size=\"2\">\n Filling out an application does not guarantee adoption. Many rescued Border Collies have special needs and some homes are simply not suitable for a typical Border Collie.\n <\/font>\n <\/li>\n <\/ul>\n <font size=\"2\">\n <br>\n <\/font>\n <ul style=\"font-family: Verdana; color: rgb(0, 0, 102);\">\n <li>\n <font size=\"2\">\n We RARELY get Border Collie puppies (under 12 mos), so if you only want a very young dog the wait could be lengthy.\n <\/font>\n <\/li>\n <\/ul>\n <font style=\"font-family: Verdana; color: rgb(0, 0, 102);\" size=\"2\">\n Please be as detailed as possible in describing your circumstances and ideal dog.\n <br>\n <br>\n We want to help you find a great, lifelong companion to bring into your home and life.\n <br>\n <br>\n We offer support in training, nutrition and health advice for the life of your dog.\n <br>\n <\/font>\n <font style=\"font-family: Verdana; color: rgb(0, 0, 102);\" size=\"2\">\n <br>\n We will keep your application on file at your request for 6 months.\n <br>\n <br>\n <\/font>\n <font style=\"font-family: Verdana;\" size=\"2\">\n <font style=\"color: rgb(0, 0, 102);\" size=\"2\">\n Below is the application for adopting a Border Collie from NEBCR. It will be reviewed by the Applications Committee and you will typically be notified within ONE WEEK as to your application status.\n <br>\n <br>\n If you have additional questions on the adoption process, please\n <a href=\"mailto:applications@nebcr.org\">contact us<\/a>\n .\n <br>\n <br>\n Sincerely,\n <br>\n New England Border Collie Rescue, Inc. (NEBCR)\n <br>\n <\/font>\n <br style=\"color: rgb(0, 0, 102);\">\n <font style=\"color: rgb(0, 0, 102);\" size=\"1\">\n Copyright 2009 All rights reserved\n <br>\n <br>\n The information contained in this application is for the express use of New England Border Collie Rescue, Inc. and may not be forwarded in whole or in part for use by any other organization or individual without the express permission of NEBCR, Inc.\n <br>\n <br>\n While we do occasionally receive requests from other rescue groups to share Home Visit reports (and will do so ONLY with the applicant's permission), we feel that it is the responsibility of each individual rescue group to properly screen their own adopters according to their specific policies and operating procedures. Any application submitted to NEBCR is kept confidential to the group and your information will not be shared elsewhere.\n <\/font>\n <br>\n <br>\n <font style=\"color: rgb(255, 0, 0);\" size=\"2\">\n IN ORDER TO RECEIVE COMMUNICATION FROM US, PLEASE ADD APPLICATIONS@NEBCR.ORG TO YOUR SPAM WHITELIST AND\/OR CHECK YOUR JUNK FOLDER FOR OUR RESPONSE.\n <br>\n <br>\n IF YOU HAVE NOT HEARD BACK FROM US WITHIN ONE WEEK, PLEASE FEEL FREE TO EMAIL APPLICATIONS@NEBCR.ORG\n <\/font>\n <br>\n <\/font>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_16\">\n <div id=\"cid_16\" class=\"form-input-wide\">\n <div id=\"text_16\" class=\"form-html\">\n Items marked with an asterisk (*) are REQUIRED fields.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_209\">\n <div id=\"cid_209\" class=\"form-input-wide\">\n <div id=\"text_209\" class=\"form-html\">\n TELL US ABOUT YOURSELF\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_18\">\n <label class=\"form-label-left\" id=\"label_18\" for=\"input_18\"> Date <\/label>\n <div id=\"cid_18\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_18\" name=\"q18_date[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"01\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_18\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_18\" name=\"q18_date[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"25\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_18\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_18\" name=\"q18_date[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_18\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_18\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_18\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_18\" name=\"q18_date[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"15\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_18\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_18\" name=\"q18_date[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"32\" \/>\n <label class=\"form-sub-label\" for=\"min_18\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_18\" name=\"q18_date[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_18\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_18_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_18_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_1\">\n <label class=\"form-label-left\" id=\"label_1\" for=\"input_1\">\n Last Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_1\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_1\" name=\"q1_lastName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_19\">\n <label class=\"form-label-left\" id=\"label_19\" for=\"input_19\">\n First Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_19\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_19\" name=\"q19_firstName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_2\">\n <label class=\"form-label-left\" id=\"label_2\" for=\"input_2\">\n E-mail<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_2\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Email]\" id=\"input_2\" name=\"q2_email\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_3\">\n <label class=\"form-label-left\" id=\"label_3\" for=\"input_3\">\n Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_3\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_3\" name=\"q3_address\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_4\">\n <label class=\"form-label-left\" id=\"label_4\" for=\"input_4\">\n City<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_4\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_4\" name=\"q4_city\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_5\">\n <label class=\"form-label-left\" id=\"label_5\" for=\"input_5\">\n State<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_5\" class=\"form-input\">\n <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_5\" name=\"q5_state\">\n <option> <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_274\">\n <label class=\"form-label-left\" id=\"label_274\" for=\"input_274\">\n Zip<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_274\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_274\" name=\"q274_zip\" size=\"20\" maxlength=\"5\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_21\">\n <label class=\"form-label-left\" id=\"label_21\" for=\"input_21\">\n Home Phone<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_21\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_21\" name=\"q21_homePhone\" size=\"20\" maxlength=\"10\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_22\">\n <label class=\"form-label-left\" id=\"label_22\" for=\"input_22\"> Work Phone <\/label>\n <div id=\"cid_22\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[Numeric]\" id=\"input_22\" name=\"q22_workPhone\" size=\"20\" maxlength=\"10\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_23\">\n <label class=\"form-label-left\" id=\"label_23\" for=\"input_23\"> Best way to contact you: <\/label>\n <div id=\"cid_23\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_23_0\" name=\"q23_bestWay\" value=\"Home Phone\" \/>\n <label for=\"input_23_0\"> Home Phone <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_23_1\" name=\"q23_bestWay\" value=\"Work Phone\" \/>\n <label for=\"input_23_1\"> Work Phone <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_23_2\" name=\"q23_bestWay\" value=\"Email\" \/>\n <label for=\"input_23_2\"> Email <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_24\">\n <label class=\"form-label-left\" id=\"label_24\" for=\"input_24\"> Age <\/label>\n <div id=\"cid_24\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[Numeric]\" id=\"input_24\" name=\"q24_age\" size=\"20\" maxlength=\"3\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_25\">\n <label class=\"form-label-left\" id=\"label_25\" for=\"input_25\"> Occupation <\/label>\n <div id=\"cid_25\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_25\" name=\"q25_occupation\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_26\">\n <label class=\"form-label-left\" id=\"label_26\" for=\"input_26\"> How did you hear about NEBCR? <\/label>\n <div id=\"cid_26\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_26\" name=\"q26_howDid\">\n <option> <\/option>\n <option value=\"Petfinder\"> Petfinder <\/option>\n <option value=\"Internet Search\"> Internet Search <\/option>\n <option value=\"Referral (explain below)\"> Referral (explain below) <\/option>\n <option value=\"Other (explain below)\"> Other (explain below) <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_27\">\n <label class=\"form-label-left\" id=\"label_27\" for=\"input_27\"> Other <\/label>\n <div id=\"cid_27\" class=\"form-input\">\n <textarea id=\"input_27\" class=\"form-textarea\" name=\"q27_other\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_29\">\n <label class=\"form-label-left\" id=\"label_29\" for=\"input_29\"> I would like to be notified about NEBCR Special Events. <\/label>\n <div id=\"cid_29\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_29_0\" name=\"q29_iWould\" value=\"Yes, please!\" \/>\n <label for=\"input_29_0\"> Yes, please! <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_29_1\" name=\"q29_iWould\" value=\"No, thanks.\" \/>\n <label for=\"input_29_1\"> No, thanks. <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_30\">\n <label class=\"form-label-left\" id=\"label_30\" for=\"input_30\"> It is OK for foster homes to notify me about dogs that they feel are a good match for my situation. <\/label>\n <div id=\"cid_30\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_30_0\" name=\"q30_itIs\" value=\"Yes, please!\" \/>\n <label for=\"input_30_0\"> Yes, please! <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_30_1\" name=\"q30_itIs\" value=\"No, thanks.\" \/>\n <label for=\"input_30_1\"> No, thanks. <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_33\">\n <div id=\"cid_33\" class=\"form-input-wide\">\n <div id=\"text_33\" class=\"form-html\">\n Please check the box below to indicate that you are aware that there is a minimum $250 adoption fee for all dogs, with the exception of our \"Seniors-for-Seniors\" program (refer back to Senior-to-Senior program information). Dogs requiring training classes will have additional deposits required.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_31\">\n <label class=\"form-label-left\" id=\"label_31\" for=\"input_31\">\n ...<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_31\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_31_0\" name=\"q31_31\" value=\"I am aware of the $250 minimum adoption fee.\" \/>\n <label for=\"input_31_0\"> I am aware of the $250 minimum adoption fee. <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_34\">\n <div id=\"cid_34\" class=\"form-input-wide\">\n <div id=\"text_34\" class=\"form-html\">\n <hr>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_35\">\n <div id=\"cid_35\" class=\"form-input-wide\">\n <div id=\"text_35\" class=\"form-html\">\n SECTION 1: YOUR FAMILY AND NEIGHBORS\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_36\">\n <label class=\"form-label-left\" id=\"label_36\" for=\"input_36\">\n Are there any other adults (18 years or older) in your household?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_36\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_36_0\" name=\"q36_areThere\" value=\"Yes\" \/>\n <label for=\"input_36_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_36_1\" name=\"q36_areThere\" value=\"No\" \/>\n <label for=\"input_36_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_38\">\n <label class=\"form-label-left\" id=\"label_38\" for=\"input_38\"> If \"Yes\", please tell us their name(s): <\/label>\n <div id=\"cid_38\" class=\"form-input\">\n <textarea id=\"input_38\" class=\"form-textarea\" name=\"q38_ifyes\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_39\">\n <label class=\"form-label-left\" id=\"label_39\" for=\"input_39\"> ...Their age(s): <\/label>\n <div id=\"cid_39\" class=\"form-input\">\n <textarea id=\"input_39\" class=\"form-textarea\" name=\"q39_theirAges\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_40\">\n <label class=\"form-label-left\" id=\"label_40\" for=\"input_40\"> ...Their occupation(s): <\/label>\n <div id=\"cid_40\" class=\"form-input\">\n <textarea id=\"input_40\" class=\"form-textarea\" name=\"q40_theirOccupations\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_41\">\n <label class=\"form-label-left\" id=\"label_41\" for=\"input_41\"> ...Their relationship to you: <\/label>\n <div id=\"cid_41\" class=\"form-input\">\n <textarea id=\"input_41\" class=\"form-textarea\" name=\"q41_theirRelationship\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_42\">\n <label class=\"form-label-left\" id=\"label_42\" for=\"input_42\"> Please list all children (names and ages) in the household (if applicable): <\/label>\n <div id=\"cid_42\" class=\"form-input\">\n <textarea id=\"input_42\" class=\"form-textarea\" name=\"q42_pleaseList\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_278\">\n <label class=\"form-label-left\" id=\"label_278\" for=\"input_278\"> Please list any responsibilities your children may have in helping with the dog's care. <\/label>\n <div id=\"cid_278\" class=\"form-input\">\n <textarea id=\"input_278\" class=\"form-textarea\" name=\"q278_pleaseList278\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_275\">\n <label class=\"form-label-left\" id=\"label_275\" for=\"input_275\"> If you currently do not have children, are you planning on having children in the future? <\/label>\n <div id=\"cid_275\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_275_0\" name=\"q275_ifYou\" value=\"Yes\" \/>\n <label for=\"input_275_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_275_1\" name=\"q275_ifYou\" value=\"No\" \/>\n <label for=\"input_275_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_46\">\n <label class=\"form-label-left\" id=\"label_46\" for=\"input_46\"> Are there a lot of children in your neighborhood? <\/label>\n <div id=\"cid_46\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_46_0\" name=\"q46_areThere46\" value=\"Yes\" \/>\n <label for=\"input_46_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_46_1\" name=\"q46_areThere46\" value=\"No\" \/>\n <label for=\"input_46_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_45\">\n <label class=\"form-label-left\" id=\"label_45\" for=\"input_45\"> Are you frequently visited by children? <\/label>\n <div id=\"cid_45\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_45_0\" name=\"q45_areYou\" value=\"Yes\" \/>\n <label for=\"input_45_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_45_1\" name=\"q45_areYou\" value=\"No\" \/>\n <label for=\"input_45_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_47\">\n <label class=\"form-label-left\" id=\"label_47\" for=\"input_47\"> Is anyone in your household allergic to dogs? <\/label>\n <div id=\"cid_47\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_47_0\" name=\"q47_isAnyone\" value=\"Yes\" \/>\n <label for=\"input_47_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_47_1\" name=\"q47_isAnyone\" value=\"No\" \/>\n <label for=\"input_47_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_48\">\n <label class=\"form-label-left\" id=\"label_48\" for=\"input_48\"> Is anyone in your household afraid of dogs? <\/label>\n <div id=\"cid_48\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_48_0\" name=\"q48_isAnyone48\" value=\"Yes\" \/>\n <label for=\"input_48_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_48_1\" name=\"q48_isAnyone48\" value=\"No\" \/>\n <label for=\"input_48_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_49\">\n <label class=\"form-label-left\" id=\"label_49\" for=\"input_49\"> Is anyone in your household elderly or frail? <\/label>\n <div id=\"cid_49\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_49_0\" name=\"q49_isAnyone49\" value=\"Yes\" \/>\n <label for=\"input_49_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_49_1\" name=\"q49_isAnyone49\" value=\"No\" \/>\n <label for=\"input_49_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_50\">\n <label class=\"form-label-left\" id=\"label_50\" for=\"input_50\"> Do you have close neighbors who might be affected adversely by a barking dog? <\/label>\n <div id=\"cid_50\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_50_0\" name=\"q50_doYou\" value=\"Yes\" \/>\n <label for=\"input_50_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_50_1\" name=\"q50_doYou\" value=\"No\" \/>\n <label for=\"input_50_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_52\">\n <div id=\"cid_52\" class=\"form-input-wide\">\n <div id=\"text_52\" class=\"form-html\">\n <hr>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_51\">\n <div id=\"cid_51\" class=\"form-input-wide\">\n <div id=\"text_51\" class=\"form-html\">\n SECTION 2: YOUR EXPERIENCE WITH DOGS\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_53\">\n <label class=\"form-label-left\" id=\"label_53\" for=\"input_53\">\n Have you ever owned a dog?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_53\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_53_0\" name=\"q53_haveYou\" value=\"Yes\" \/>\n <label for=\"input_53_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_53_1\" name=\"q53_haveYou\" value=\"No\" \/>\n <label for=\"input_53_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_59\">\n <label class=\"form-label-left\" id=\"label_59\" for=\"input_59\">\n Please give us a brief history of your past dog ownership. Please tell us the breeds, length of ownerships and what happened with each dog. (enter \"n\/a\" if not applicable)<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_59\" class=\"form-input\">\n <textarea id=\"input_59\" class=\"form-textarea validate[required]\" name=\"q59_pleaseGive\" cols=\"30\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_54\">\n <label class=\"form-label-left\" id=\"label_54\" for=\"input_54\">\n Do you currently own a dog?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_54\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_54_0\" name=\"q54_doYou54\" value=\"Yes\" \/>\n <label for=\"input_54_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_54_1\" name=\"q54_doYou54\" value=\"No\" \/>\n <label for=\"input_54_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_63\">\n <div id=\"cid_63\" class=\"form-input-wide\">\n <div id=\"text_63\" class=\"form-html\">\n For EACH dog you currently own, please answer the following questions:\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_66\">\n <label class=\"form-label-left\" id=\"label_66\" for=\"input_66\"> Dog 1 Name: <\/label>\n <div id=\"cid_66\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_66\" name=\"q66_dog1\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_67\">\n <label class=\"form-label-left\" id=\"label_67\" for=\"input_67\"> Breed: <\/label>\n <div id=\"cid_67\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_67\" name=\"q67_breed\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_68\">\n <label class=\"form-label-left\" id=\"label_68\" for=\"input_68\"> Gender: <\/label>\n <div id=\"cid_68\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_68\" name=\"q68_gender\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_69\">\n <label class=\"form-label-left\" id=\"label_69\" for=\"input_69\"> Age: <\/label>\n <div id=\"cid_69\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_69\" name=\"q69_age69\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_70\">\n <label class=\"form-label-left\" id=\"label_70\" for=\"input_70\"> Please describe your dog's temperament, particularly in regard to other dogs: <\/label>\n <div id=\"cid_70\" class=\"form-input\">\n <textarea id=\"input_70\" class=\"form-textarea\" name=\"q70_pleaseDescribe\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_71\">\n <label class=\"form-label-left\" id=\"label_71\" for=\"input_71\"> Is this dog: <\/label>\n <div id=\"cid_71\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_71_0\" name=\"q71_isThis\" value=\"Spayed\" \/>\n <label for=\"input_71_0\"> Spayed <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_71_1\" name=\"q71_isThis\" value=\"Neutered\" \/>\n <label for=\"input_71_1\"> Neutered <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_71_2\" name=\"q71_isThis\" value=\"Neither\" \/>\n <label for=\"input_71_2\"> Neither <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_72\">\n <label class=\"form-label-left\" id=\"label_72\" for=\"input_72\"> Vaccination status: <\/label>\n <div id=\"cid_72\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_72_0\" name=\"q72_vaccinationStatus\" value=\"Up to date\" \/>\n <label for=\"input_72_0\"> Up to date <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_72_1\" name=\"q72_vaccinationStatus\" value=\"Needs updating\" \/>\n <label for=\"input_72_1\"> Needs updating <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_72_2\" name=\"q72_vaccinationStatus\" value=\"I don't vaccinate (please explain)\" \/>\n <label for=\"input_72_2\"> I don't vaccinate (please explain) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_72_3\" name=\"q72_vaccinationStatus\" value=\"I titer my dogs\" \/>\n <label for=\"input_72_3\"> I titer my dogs <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_72_4\" name=\"q72_vaccinationStatus\" value=\"Other\" \/>\n <label for=\"input_72_4\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_210\">\n <label class=\"form-label-left\" id=\"label_210\" for=\"input_210\"> If \"Other\", please explain: <\/label>\n <div id=\"cid_210\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_210\" name=\"q210_ifother\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_211\">\n <label class=\"form-label-left\" id=\"label_211\" for=\"input_211\"> Do you use Heartworm preventative on this dog? <\/label>\n <div id=\"cid_211\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_211_0\" name=\"q211_doYou211\" value=\"Yes\" \/>\n <label for=\"input_211_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_211_1\" name=\"q211_doYou211\" value=\"No\" \/>\n <label for=\"input_211_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_212\">\n <label class=\"form-label-left\" id=\"label_212\" for=\"input_212\"> If \"No\", please explain why: <\/label>\n <div id=\"cid_212\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_212\" name=\"q212_ifno\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_74\">\n <label class=\"form-label-left\" id=\"label_74\" for=\"input_74\"> Is this dog's license up to date? <\/label>\n <div id=\"cid_74\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_74_0\" name=\"q74_isThis74\" value=\"Yes\" \/>\n <label for=\"input_74_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_74_1\" name=\"q74_isThis74\" value=\"No\" \/>\n <label for=\"input_74_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_74_2\" name=\"q74_isThis74\" value=\"My town doesn't require licenses\" \/>\n <label for=\"input_74_2\"> My town doesn't require licenses <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_75\">\n <label class=\"form-label-left\" id=\"label_75\" for=\"input_75\"> Dog 2 Name: <\/label>\n <div id=\"cid_75\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_75\" name=\"q75_dog2\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_76\">\n <label class=\"form-label-left\" id=\"label_76\" for=\"input_76\"> Breed: <\/label>\n <div id=\"cid_76\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_76\" name=\"q76_breed76\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_77\">\n <label class=\"form-label-left\" id=\"label_77\" for=\"input_77\"> Gender: <\/label>\n <div id=\"cid_77\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_77\" name=\"q77_gender77\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_78\">\n <label class=\"form-label-left\" id=\"label_78\" for=\"input_78\"> Age <\/label>\n <div id=\"cid_78\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_78\" name=\"q78_age78\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_79\">\n <label class=\"form-label-left\" id=\"label_79\" for=\"input_79\"> Please describe your dog's temperament, particularly in regard to other dogs: <\/label>\n <div id=\"cid_79\" class=\"form-input\">\n <textarea id=\"input_79\" class=\"form-textarea\" name=\"q79_pleaseDescribe79\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_80\">\n <label class=\"form-label-left\" id=\"label_80\" for=\"input_80\"> Is this dog: <\/label>\n <div id=\"cid_80\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_80_0\" name=\"q80_isThis80\" value=\"Spayed\" \/>\n <label for=\"input_80_0\"> Spayed <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_80_1\" name=\"q80_isThis80\" value=\"Neutered\" \/>\n <label for=\"input_80_1\"> Neutered <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_80_2\" name=\"q80_isThis80\" value=\"Neither\" \/>\n <label for=\"input_80_2\"> Neither <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_81\">\n <label class=\"form-label-left\" id=\"label_81\" for=\"input_81\"> Vaccination status: <\/label>\n <div id=\"cid_81\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_81_0\" name=\"q81_vaccinationStatus81\" value=\"Up to date\" \/>\n <label for=\"input_81_0\"> Up to date <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_81_1\" name=\"q81_vaccinationStatus81\" value=\"Needs updating\" \/>\n <label for=\"input_81_1\"> Needs updating <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_81_2\" name=\"q81_vaccinationStatus81\" value=\"I don't vaccinate\" \/>\n <label for=\"input_81_2\"> I don't vaccinate <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_81_3\" name=\"q81_vaccinationStatus81\" value=\"I titer my dogs\" \/>\n <label for=\"input_81_3\"> I titer my dogs <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_81_4\" name=\"q81_vaccinationStatus81\" value=\"Other\" \/>\n <label for=\"input_81_4\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_215\">\n <label class=\"form-label-left\" id=\"label_215\" for=\"input_215\"> If \"Other\", please explain: <\/label>\n <div id=\"cid_215\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_215\" name=\"q215_ifother215\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_213\">\n <label class=\"form-label-left\" id=\"label_213\" for=\"input_213\"> Do you use Heartworm preventative on this dog? <\/label>\n <div id=\"cid_213\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_213_0\" name=\"q213_doYou213\" value=\"Yes\" \/>\n <label for=\"input_213_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_213_1\" name=\"q213_doYou213\" value=\"No\" \/>\n <label for=\"input_213_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_214\">\n <label class=\"form-label-left\" id=\"label_214\" for=\"input_214\"> If \"No\", please explain why: <\/label>\n <div id=\"cid_214\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_214\" name=\"q214_ifno214\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_83\">\n <label class=\"form-label-left\" id=\"label_83\" for=\"input_83\"> Is this dog's license up to date? <\/label>\n <div id=\"cid_83\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_83_0\" name=\"q83_isThis83\" value=\"Yes\" \/>\n <label for=\"input_83_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_83_1\" name=\"q83_isThis83\" value=\"No\" \/>\n <label for=\"input_83_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_83_2\" name=\"q83_isThis83\" value=\"My town doesn't require licenses\" \/>\n <label for=\"input_83_2\"> My town doesn't require licenses <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_84\">\n <label class=\"form-label-left\" id=\"label_84\" for=\"input_84\"> If you have additional dogs, please provide the information above for each additional dog here: <\/label>\n <div id=\"cid_84\" class=\"form-input\">\n <textarea id=\"input_84\" class=\"form-textarea\" name=\"q84_ifYou84\" cols=\"30\" rows=\"4\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_287\">\n <label class=\"form-label-left\" id=\"label_287\" for=\"input_287\"> If any of your dogs are not spayed or neutered, please explain why: <\/label>\n <div id=\"cid_287\" class=\"form-input\">\n <textarea id=\"input_287\" class=\"form-textarea\" name=\"q287_ifAny\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_85\">\n <label class=\"form-label-left\" id=\"label_85\" for=\"input_85\"> Why have you decided to get a dog (or another dog) at this point? <\/label>\n <div id=\"cid_85\" class=\"form-input\">\n <textarea id=\"input_85\" class=\"form-textarea\" name=\"q85_whyHave\" cols=\"30\" rows=\"3\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_86\">\n <label class=\"form-label-left\" id=\"label_86\" for=\"input_86\">\n Why have you decided to get a Border Collie?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_86\" class=\"form-input\">\n <textarea id=\"input_86\" class=\"form-textarea validate[required]\" name=\"q86_whyHave86\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_89\">\n <label class=\"form-label-left\" id=\"label_89\" for=\"input_89\">\n Please explain what you believe to be the special characteristics of Border Collies:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_89\" class=\"form-input\">\n <textarea id=\"input_89\" class=\"form-textarea validate[required]\" name=\"q89_pleaseExplain\" cols=\"30\" rows=\"3\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_90\">\n <label class=\"form-label-left\" id=\"label_90\" for=\"input_90\"> Have you ever adopted an animal from a shelter or rescue group before? <\/label>\n <div id=\"cid_90\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_90_0\" name=\"q90_haveYou90\" value=\"Yes\" \/>\n <label for=\"input_90_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_90_1\" name=\"q90_haveYou90\" value=\"No\" \/>\n <label for=\"input_90_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_91\">\n <label class=\"form-label-left\" id=\"label_91\" for=\"input_91\"> If \"Yes\", please provide the name, address and telephone number of the shelter or rescue as a reference: <\/label>\n <div id=\"cid_91\" class=\"form-input\">\n <textarea id=\"input_91\" class=\"form-textarea\" name=\"q91_ifyes91\" cols=\"30\" rows=\"4\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_92\">\n <label class=\"form-label-left\" id=\"label_92\" for=\"input_92\">\n Have you ever surrendered an animal to a shelter or rescue group or personally rehomed a dog?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_92\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_92_0\" name=\"q92_haveYou92\" value=\"Yes\" \/>\n <label for=\"input_92_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_92_1\" name=\"q92_haveYou92\" value=\"No\" \/>\n <label for=\"input_92_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_93\">\n <label class=\"form-label-left\" id=\"label_93\" for=\"input_93\"> If \"Yes\", please describe the circumstances: <\/label>\n <div id=\"cid_93\" class=\"form-input\">\n <textarea id=\"input_93\" class=\"form-textarea\" name=\"q93_ifyes93\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_94\">\n <label class=\"form-label-left\" id=\"label_94\" for=\"input_94\"> Have you ever been attacked or bitten by a dog? <\/label>\n <div id=\"cid_94\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_94_0\" name=\"q94_haveYou94\" value=\"Yes\" \/>\n <label for=\"input_94_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_94_1\" name=\"q94_haveYou94\" value=\"No\" \/>\n <label for=\"input_94_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_95\">\n <label class=\"form-label-left\" id=\"label_95\" for=\"input_95\"> If \"Yes\", please describe the circumstances and what you would have done differently in the situation: <\/label>\n <div id=\"cid_95\" class=\"form-input\">\n <textarea id=\"input_95\" class=\"form-textarea\" name=\"q95_ifyes95\" cols=\"30\" rows=\"4\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_97\">\n <label class=\"form-label-left\" id=\"label_97\" for=\"input_97\"> What are the requirements for obtaining a dog license in your town? <\/label>\n <div id=\"cid_97\" class=\"form-input\">\n <textarea id=\"input_97\" class=\"form-textarea\" name=\"q97_whatAre\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_106\">\n <div id=\"cid_106\" class=\"form-input-wide\">\n <div id=\"text_106\" class=\"form-html\">\n <hr>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_101\">\n <div id=\"cid_101\" class=\"form-input-wide\">\n <div id=\"text_101\" class=\"form-html\">\n REFERENCES:\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_105\">\n <div id=\"cid_105\" class=\"form-input-wide\">\n <div id=\"text_105\" class=\"form-html\">\n <font style=\"color: rgb(57, 79, 95);\" size=\"2\"><span style=\"font-family: Verdana;\">Please list your vet and three people who are knowledgeable about you and your care of dogs. The three references should be people in the dog community (for example, a trainer, a groomer, a rescue person, or someone who has dogs and knows you well). You may include a shelter or rescue person that you once adopted a dog from if you listed one above. If you do not know a person in the dog community that can give you a reference, please list three people who can give you a character reference, like\n an employer, a clergyman, or a teacher.\n <br>\n <br>\n Without references we CANNOT complete your evaluation.\n <br><\/span>\n <\/font>\n <ul style=\"color: rgb(57, 79, 95);\">\n <li>\n <font style=\"color: rgb(0, 51, 102);\" size=\"2\"><span style=\"font-family: Verdana;\">Please provide a valid phone number and\/or email address for each person listed.<\/span>\n <\/font>\n <\/li>\n <li>\n <font style=\"color: rgb(0, 51, 102);\" size=\"2\"><span style=\"font-family: Verdana;\">Please do not use more than ONE immediate family member as a reference.<\/span>\n <\/font>\n <\/li>\n <\/ul>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_107\">\n <div id=\"cid_107\" class=\"form-input-wide\">\n <div id=\"text_107\" class=\"form-html\">\n Veterinary Reference:\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_108\">\n <label class=\"form-label-left\" id=\"label_108\" for=\"input_108\"> Name of Vet: <\/label>\n <div id=\"cid_108\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_108\" name=\"q108_nameOf\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_109\">\n <label class=\"form-label-left\" id=\"label_109\" for=\"input_109\">\n Name of Practice:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_109\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_109\" name=\"q109_nameOf109\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_110\">\n <label class=\"form-label-left\" id=\"label_110\" for=\"input_110\"> Email: <\/label>\n <div id=\"cid_110\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_110\" name=\"q110_email110\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_111\">\n <label class=\"form-label-left\" id=\"label_111\" for=\"input_111\">\n Phone:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_111\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_111\" name=\"q111_phone\" size=\"20\" maxlength=\"10\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_112\">\n <div id=\"cid_112\" class=\"form-input-wide\">\n <div id=\"text_112\" class=\"form-html\">\n Reference 1:\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_113\">\n <label class=\"form-label-left\" id=\"label_113\" for=\"input_113\">\n Name:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_113\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_113\" name=\"q113_name\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_114\">\n <label class=\"form-label-left\" id=\"label_114\" for=\"input_114\">\n Phone:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_114\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_114\" name=\"q114_phone114\" size=\"20\" maxlength=\"10\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_115\">\n <label class=\"form-label-left\" id=\"label_115\" for=\"input_115\"> Email: <\/label>\n <div id=\"cid_115\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_115\" name=\"q115_email115\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_116\">\n <label class=\"form-label-left\" id=\"label_116\" for=\"input_116\"> Relation to you: <\/label>\n <div id=\"cid_116\" class=\"form-input\">\n <textarea id=\"input_116\" class=\"form-textarea\" name=\"q116_relationTo\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_117\">\n <div id=\"cid_117\" class=\"form-input-wide\">\n <div id=\"text_117\" class=\"form-html\">\n Reference 2:\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_118\">\n <label class=\"form-label-left\" id=\"label_118\" for=\"input_118\">\n Name:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_118\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_118\" name=\"q118_name118\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_120\">\n <label class=\"form-label-left\" id=\"label_120\" for=\"input_120\">\n Phone:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_120\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_120\" name=\"q120_phone120\" size=\"20\" maxlength=\"10\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_119\">\n <label class=\"form-label-left\" id=\"label_119\" for=\"input_119\"> Email: <\/label>\n <div id=\"cid_119\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_119\" name=\"q119_email119\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_121\">\n <label class=\"form-label-left\" id=\"label_121\" for=\"input_121\"> Relation to you: <\/label>\n <div id=\"cid_121\" class=\"form-input\">\n <textarea id=\"input_121\" class=\"form-textarea\" name=\"q121_relationTo121\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_122\">\n <div id=\"cid_122\" class=\"form-input-wide\">\n <div id=\"text_122\" class=\"form-html\">\n Reference 3:\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_123\">\n <label class=\"form-label-left\" id=\"label_123\" for=\"input_123\">\n Name:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_123\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_123\" name=\"q123_name123\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_124\">\n <label class=\"form-label-left\" id=\"label_124\" for=\"input_124\">\n Phone:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_124\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_124\" name=\"q124_phone124\" size=\"20\" maxlength=\"10\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_125\">\n <label class=\"form-label-left\" id=\"label_125\" for=\"input_125\"> Email: <\/label>\n <div id=\"cid_125\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_125\" name=\"q125_email125\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_126\">\n <label class=\"form-label-left\" id=\"label_126\" for=\"input_126\"> Relation to you: <\/label>\n <div id=\"cid_126\" class=\"form-input\">\n <textarea id=\"input_126\" class=\"form-textarea\" name=\"q126_relationTo126\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_127\">\n <div id=\"cid_127\" class=\"form-input-wide\">\n <div id=\"text_127\" class=\"form-html\">\n <hr>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_128\">\n <div id=\"cid_128\" class=\"form-input-wide\">\n <div id=\"text_128\" class=\"form-html\">\n SECTION 3: YOUR PREFERENCE WITH DOGS\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_131\">\n <label class=\"form-label-left\" id=\"label_131\" for=\"input_131\"> Preferred age range (select all that apply) <\/label>\n <div id=\"cid_131\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_131_0\" name=\"q131_preferredAge[]\" value=\"Puppy (under 1yr)\" \/>\n <label for=\"input_131_0\"> Puppy (under 1yr) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_131_1\" name=\"q131_preferredAge[]\" value=\"Young (1 - 4)\" \/>\n <label for=\"input_131_1\"> Young (1 - 4) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_131_2\" name=\"q131_preferredAge[]\" value=\"Middle Aged (5 - 10)\" \/>\n <label for=\"input_131_2\"> Middle Aged (5 - 10) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_131_3\" name=\"q131_preferredAge[]\" value=\"Senior (10+)\" \/>\n <label for=\"input_131_3\"> Senior (10+) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_130\">\n <label class=\"form-label-left\" id=\"label_130\" for=\"input_130\"> Gender: <\/label>\n <div id=\"cid_130\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_130_0\" name=\"q130_gender130\" value=\"Male\" \/>\n <label for=\"input_130_0\"> Male <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_130_1\" name=\"q130_gender130\" value=\"Female\" \/>\n <label for=\"input_130_1\"> Female <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_130_2\" name=\"q130_gender130\" value=\"No Preference\" \/>\n <label for=\"input_130_2\"> No Preference <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_132\">\n <label class=\"form-label-left\" id=\"label_132\" for=\"input_132\"> Would you consider a Border Collie mix? <\/label>\n <div id=\"cid_132\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_132_0\" name=\"q132_wouldYou\" value=\"Yes\" \/>\n <label for=\"input_132_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_132_1\" name=\"q132_wouldYou\" value=\"No\" \/>\n <label for=\"input_132_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_133\">\n <label class=\"form-label-left\" id=\"label_133\" for=\"input_133\"> Would you consider a dog that has a physical problem (for example, hip dysplasia, epilepsy, etc.) that might be cured with drugs or surgery? <\/label>\n <div id=\"cid_133\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_133_0\" name=\"q133_wouldYou133\" value=\"Yes\" \/>\n <label for=\"input_133_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_133_1\" name=\"q133_wouldYou133\" value=\"No\" \/>\n <label for=\"input_133_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_133_2\" name=\"q133_wouldYou133\" value=\"Maybe\" \/>\n <label for=\"input_133_2\"> Maybe <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_134\">\n <label class=\"form-label-left\" id=\"label_134\" for=\"input_134\"> Would you consider a dog that has an emotional problem (for example, separation anxiety, fear reactivity, etc.) that might be controlled or cured with training, behavior modification or with drugs? <\/label>\n <div id=\"cid_134\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_134_0\" name=\"q134_wouldYou134\" value=\"Yes\" \/>\n <label for=\"input_134_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_134_1\" name=\"q134_wouldYou134\" value=\"No\" \/>\n <label for=\"input_134_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_134_2\" name=\"q134_wouldYou134\" value=\"Maybe\" \/>\n <label for=\"input_134_2\"> Maybe <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_137\">\n <label class=\"form-label-left\" id=\"label_137\" for=\"input_137\"> After researching the breed, please list any Border Collie-specific traits that you would like to avoid: <\/label>\n <div id=\"cid_137\" class=\"form-input\">\n <textarea id=\"input_137\" class=\"form-textarea\" name=\"q137_afterResearching\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_138\">\n <label class=\"form-label-left\" id=\"label_138\" for=\"input_138\"> Are you considering adopting more than one dog? <\/label>\n <div id=\"cid_138\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_138_0\" name=\"q138_areYou138\" value=\"Yes\" \/>\n <label for=\"input_138_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_138_1\" name=\"q138_areYou138\" value=\"No\" \/>\n <label for=\"input_138_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_140\">\n <label class=\"form-label-left\" id=\"label_140\" for=\"input_140\">\n What type of dog are you looking for (check all that apply):<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_140\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_140_0\" name=\"q140_whatType[]\" value=\"Family pet \/ companion\" \/>\n <label for=\"input_140_0\"> Family pet \/ companion <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_140_1\" name=\"q140_whatType[]\" value=\"Sport \/ Competition\" \/>\n <label for=\"input_140_1\"> Sport \/ Competition <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_140_2\" name=\"q140_whatType[]\" value=\"Working dog (stock \/ herding)\" \/>\n <label for=\"input_140_2\"> Working dog (stock \/ herding) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_141\">\n <label class=\"form-label-left\" id=\"label_141\" for=\"input_141\"> If you selected 'Working dog', please explain what type of herding \/ stock: <\/label>\n <div id=\"cid_141\" class=\"form-input\">\n <textarea id=\"input_141\" class=\"form-textarea\" name=\"q141_ifYou141\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_142\">\n <label class=\"form-label-left\" id=\"label_142\" for=\"input_142\"> If you selected 'Working dog', do you have experience training dogs for stock work? <\/label>\n <div id=\"cid_142\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_142_0\" name=\"q142_ifYou142\" value=\"Yes\" \/>\n <label for=\"input_142_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_142_1\" name=\"q142_ifYou142\" value=\"No\" \/>\n <label for=\"input_142_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_142_2\" name=\"q142_ifYou142\" value=\"No, but I have a trainer lined up.\" \/>\n <label for=\"input_142_2\"> No, but I have a trainer lined up. <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_144\">\n <label class=\"form-label-left\" id=\"label_144\" for=\"input_144\"> Please provide the trainer's name: <\/label>\n <div id=\"cid_144\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_144\" name=\"q144_pleaseProvide\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_143\">\n <div id=\"cid_143\" class=\"form-input-wide\">\n <div id=\"text_143\" class=\"form-html\">\n PLEASE NOTE: It is extremely rare that we get border collies into rescue with actual herding training\/experience. While it is true that the instinct is present in many Border Collies, the amount of drive\/ability varies from dog to dog. If you are looking for a herding dog and do not have experience training one in the past, we will require that you provide a trainer reference before considering you for any particular dog.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_145\">\n <div id=\"cid_145\" class=\"form-input-wide\">\n <div id=\"text_145\" class=\"form-html\">\n <hr>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_147\">\n <label class=\"form-label-left\" id=\"label_147\" for=\"input_147\"> Is there a specific dog on our website that interests you? <\/label>\n <div id=\"cid_147\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_147_0\" name=\"q147_isThere\" value=\"Yes\" \/>\n <label for=\"input_147_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_147_1\" name=\"q147_isThere\" value=\"No\" \/>\n <label for=\"input_147_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_148\">\n <label class=\"form-label-left\" id=\"label_148\" for=\"input_148\"> If so, please list which one(s): <\/label>\n <div id=\"cid_148\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_148\" name=\"q148_ifSo\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_149\">\n <label class=\"form-label-left\" id=\"label_149\" for=\"input_149\"> Please explain why you think this particular dog may be a match for your household: <\/label>\n <div id=\"cid_149\" class=\"form-input\">\n <textarea id=\"input_149\" class=\"form-textarea\" name=\"q149_pleaseExplain149\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_150\">\n <div id=\"cid_150\" class=\"form-input-wide\">\n <div id=\"text_150\" class=\"form-html\">\n <hr>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_151\">\n <div id=\"cid_151\" class=\"form-input-wide\">\n <div id=\"text_151\" class=\"form-html\">\n SECTION 4: YOUR ENVIRONMENT\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_152\">\n <label class=\"form-label-left\" id=\"label_152\" for=\"input_152\">\n Is your neighborhood:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_152\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_152_0\" name=\"q152_isYour\" value=\"Urban\" \/>\n <label for=\"input_152_0\"> Urban <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_152_1\" name=\"q152_isYour\" value=\"Rural\" \/>\n <label for=\"input_152_1\"> Rural <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_152_2\" name=\"q152_isYour\" value=\"Suburban\" \/>\n <label for=\"input_152_2\"> Suburban <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_153\">\n <label class=\"form-label-left\" id=\"label_153\" for=\"input_153\"> Do you live in an: <\/label>\n <div id=\"cid_153\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_153_0\" name=\"q153_doYou153\" value=\"Apartment\" \/>\n <label for=\"input_153_0\"> Apartment <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_153_1\" name=\"q153_doYou153\" value=\"Condo\" \/>\n <label for=\"input_153_1\"> Condo <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_153_2\" name=\"q153_doYou153\" value=\"Mobile Home\" \/>\n <label for=\"input_153_2\"> Mobile Home <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_153_3\" name=\"q153_doYou153\" value=\"Single Family Home\" \/>\n <label for=\"input_153_3\"> Single Family Home <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_153_4\" name=\"q153_doYou153\" value=\"Farm\" \/>\n <label for=\"input_153_4\"> Farm <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_153_5\" name=\"q153_doYou153\" value=\"Military Housing\" \/>\n <label for=\"input_153_5\"> Military Housing <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_153_6\" name=\"q153_doYou153\" value=\"Other\" \/>\n <label for=\"input_153_6\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_217\">\n <label class=\"form-label-left\" id=\"label_217\" for=\"input_217\"> If \"Other\", please describe: <\/label>\n <div id=\"cid_217\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_217\" name=\"q217_ifother217\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_218\">\n <label class=\"form-label-left\" id=\"label_218\" for=\"input_218\"> Do you: <\/label>\n <div id=\"cid_218\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_218_0\" name=\"q218_doYou218\" value=\"Own\" \/>\n <label for=\"input_218_0\"> Own <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_218_1\" name=\"q218_doYou218\" value=\"Rent\" \/>\n <label for=\"input_218_1\"> Rent <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_219\">\n <label class=\"form-label-left\" id=\"label_219\" for=\"input_219\"> If you Rent, do you have permission to have pets on the property? <\/label>\n <div id=\"cid_219\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_219_0\" name=\"q219_ifYou219\" value=\"Yes\" \/>\n <label for=\"input_219_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_219_1\" name=\"q219_ifYou219\" value=\"No\" \/>\n <label for=\"input_219_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_220\">\n <label class=\"form-label-left\" id=\"label_220\" for=\"input_220\"> If \"Yes\", please provide your landlord's name and contact information: <\/label>\n <div id=\"cid_220\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_220\" name=\"q220_ifyes220\" size=\"30\" maxlength=\"500\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_266\">\n <label class=\"form-label-left\" id=\"label_266\" for=\"input_266\"> Would you ever move to a house or apartment that doesn't allow dogs? <\/label>\n <div id=\"cid_266\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_266_0\" name=\"q266_wouldYou266\" value=\"Yes\" \/>\n <label for=\"input_266_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_266_1\" name=\"q266_wouldYou266\" value=\"No\" \/>\n <label for=\"input_266_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_222\">\n <label class=\"form-label-left\" id=\"label_222\" for=\"input_222\"> Do you: (check all that apply) <\/label>\n <div id=\"cid_222\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_222_0\" name=\"q222_doYou222[]\" value=\"Have close neighbors (on sides)\" \/>\n <label for=\"input_222_0\"> Have close neighbors (on sides) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_222_1\" name=\"q222_doYou222[]\" value=\"Live in a multi-family home\" \/>\n <label for=\"input_222_1\"> Live in a multi-family home <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_223\">\n <label class=\"form-label-left\" id=\"label_223\" for=\"input_223\"> If you checked either of the above, are they aware that you intend to adopt a dog? <\/label>\n <div id=\"cid_223\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_223_0\" name=\"q223_ifYou223\" value=\"Yes\" \/>\n <label for=\"input_223_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_223_1\" name=\"q223_ifYou223\" value=\"No\" \/>\n <label for=\"input_223_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_224\">\n <label class=\"form-label-left\" id=\"label_224\" for=\"input_224\"> Are there any restrictions as to the number of dogs and\/or combination of dogs and cats you are allowed to have in your town\/residence? <\/label>\n <div id=\"cid_224\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_224_0\" name=\"q224_areThere224\" value=\"Yes, and I'm within the limit\" \/>\n <label for=\"input_224_0\"> Yes, and I'm within the limit <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_224_1\" name=\"q224_areThere224\" value=\"No restrictions\" \/>\n <label for=\"input_224_1\"> No restrictions <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_230\">\n <label class=\"form-label-left\" id=\"label_230\" for=\"input_230\"> Do you have other pets in the house (besides those you may have already listed)? <\/label>\n <div id=\"cid_230\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_230_0\" name=\"q230_doYou230\" value=\"Yes\" \/>\n <label for=\"input_230_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_230_1\" name=\"q230_doYou230\" value=\"No\" \/>\n <label for=\"input_230_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_232\">\n <label class=\"form-label-left\" id=\"label_232\" for=\"input_232\"> If \"Yes\", how many and what type? <\/label>\n <div id=\"cid_232\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_232\" name=\"q232_ifyes232\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_226\">\n <label class=\"form-label-left\" id=\"label_226\" for=\"input_226\"> Do you own livestock? <\/label>\n <div id=\"cid_226\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_226_0\" name=\"q226_doYou226\" value=\"Yes\" \/>\n <label for=\"input_226_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_226_1\" name=\"q226_doYou226\" value=\"No\" \/>\n <label for=\"input_226_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_227\">\n <label class=\"form-label-left\" id=\"label_227\" for=\"input_227\"> If \"Yes\", how many and what type? <\/label>\n <div id=\"cid_227\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_227\" name=\"q227_ifyes227\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_229\">\n <label class=\"form-label-left\" id=\"label_229\" for=\"input_229\"> Do you live on or near a busy road? <\/label>\n <div id=\"cid_229\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_229_0\" name=\"q229_doYou229\" value=\"Yes\" \/>\n <label for=\"input_229_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_229_1\" name=\"q229_doYou229\" value=\"No\" \/>\n <label for=\"input_229_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_225\">\n <label class=\"form-label-left\" id=\"label_225\" for=\"input_225\"> How large is your property? <\/label>\n <div id=\"cid_225\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_225\" name=\"q225_howLarge\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_233\">\n <label class=\"form-label-left\" id=\"label_233\" for=\"input_233\"> Do you have a: (check all that apply) <\/label>\n <div id=\"cid_233\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_233_0\" name=\"q233_doYou233[]\" value=\"Open Yard\" \/>\n <label for=\"input_233_0\"> Open Yard <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_233_1\" name=\"q233_doYou233[]\" value=\"Fenced Yard\" \/>\n <label for=\"input_233_1\"> Fenced Yard <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_233_2\" name=\"q233_doYou233[]\" value=\"Fenced Kennel Area\" \/>\n <label for=\"input_233_2\"> Fenced Kennel Area <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_233_3\" name=\"q233_doYou233[]\" value=\"Invisible Fenced Yard\" \/>\n <label for=\"input_233_3\"> Invisible Fenced Yard <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_234\">\n <label class=\"form-label-left\" id=\"label_234\" for=\"input_234\"> If you have a fence or kennel, what type is it (e.g. stockade, chain link, etc.)? <\/label>\n <div id=\"cid_234\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_234\" name=\"q234_ifYou234\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_235\">\n <label class=\"form-label-left\" id=\"label_235\" for=\"input_235\"> How large is the enclosed area? <\/label>\n <div id=\"cid_235\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_235\" name=\"q235_howLarge235\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_236\">\n <label class=\"form-label-left\" id=\"label_236\" for=\"input_236\"> How high is the fence \/ kennel? <\/label>\n <div id=\"cid_236\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_236\" name=\"q236_howHigh\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_238\">\n <div id=\"cid_238\" class=\"form-input-wide\">\n <div id=\"text_238\" class=\"form-html\">\n <hr>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_237\">\n <div id=\"cid_237\" class=\"form-input-wide\">\n <div id=\"text_237\" class=\"form-html\">\n SECTION 5: YOUR \"DOG\" LIFESTYLE\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_239\">\n <div id=\"cid_239\" class=\"form-input-wide\">\n <div id=\"text_239\" class=\"form-html\">\n All of our dogs are in volunteer foster homes spread throughout New England. It may be possible that the dog you're interested in is several states away, and significant travel may be necessary.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_241\">\n <label class=\"form-label-left\" id=\"label_241\" for=\"input_241\"> How far are you willing to travel for the right dog? <\/label>\n <div id=\"cid_241\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_241\" name=\"q241_howFar\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_243\">\n <label class=\"form-label-left\" id=\"label_243\" for=\"input_243\"> How long will the dog be alone on most days? <\/label>\n <div id=\"cid_243\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_243\" name=\"q243_howLong\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_244\">\n <label class=\"form-label-left\" id=\"label_244\" for=\"input_244\">\n WHEN NO ONE IS HOME, where will the dog be kept? (e.g. when you're at work, running errands, out to dinner, etc) Check all that apply<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_244\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_244_0\" name=\"q244_whenNo[]\" value=\"In a crate\" \/>\n <label for=\"input_244_0\"> In a crate <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_244_1\" name=\"q244_whenNo[]\" value=\"Free roam of house\" \/>\n <label for=\"input_244_1\"> Free roam of house <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_244_2\" name=\"q244_whenNo[]\" value=\"Gated \/ shut in safe room(s)\" \/>\n <label for=\"input_244_2\"> Gated \/ shut in safe room(s) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_244_3\" name=\"q244_whenNo[]\" value=\"Free roam of neighborhood\" \/>\n <label for=\"input_244_3\"> Free roam of neighborhood <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_244_4\" name=\"q244_whenNo[]\" value=\"Loose in fenced yard\" \/>\n <label for=\"input_244_4\"> Loose in fenced yard <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_244_5\" name=\"q244_whenNo[]\" value=\"Loose in Invisible Fenced yard\" \/>\n <label for=\"input_244_5\"> Loose in Invisible Fenced yard <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_244_6\" name=\"q244_whenNo[]\" value=\"Tied in yard\" \/>\n <label for=\"input_244_6\"> Tied in yard <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_244_7\" name=\"q244_whenNo[]\" value=\"Other\" \/>\n <label for=\"input_244_7\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_246\">\n <label class=\"form-label-left\" id=\"label_246\" for=\"input_246\"> If \"Other\", please explain: <\/label>\n <div id=\"cid_246\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_246\" name=\"q246_ifother246\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_247\">\n <label class=\"form-label-left\" id=\"label_247\" for=\"input_247\"> AT NIGHT, where will the dog be kept? Check all that apply <\/label>\n <div id=\"cid_247\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_247_0\" name=\"q247_atNight[]\" value=\"In a crate\" \/>\n <label for=\"input_247_0\"> In a crate <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_247_1\" name=\"q247_atNight[]\" value=\"Free roam of house\" \/>\n <label for=\"input_247_1\"> Free roam of house <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_247_2\" name=\"q247_atNight[]\" value=\"Gated \/ shut in safe room(s)\" \/>\n <label for=\"input_247_2\"> Gated \/ shut in safe room(s) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_247_3\" name=\"q247_atNight[]\" value=\"Free roam of neighborhood\" \/>\n <label for=\"input_247_3\"> Free roam of neighborhood <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_247_4\" name=\"q247_atNight[]\" value=\"Loose in fenced yard\" \/>\n <label for=\"input_247_4\"> Loose in fenced yard <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_247_5\" name=\"q247_atNight[]\" value=\"Loose in Invisible Fenced yard\" \/>\n <label for=\"input_247_5\"> Loose in Invisible Fenced yard <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_247_6\" name=\"q247_atNight[]\" value=\"Tied in yard\" \/>\n <label for=\"input_247_6\"> Tied in yard <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_247_7\" name=\"q247_atNight[]\" value=\"Other\" \/>\n <label for=\"input_247_7\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_249\">\n <label class=\"form-label-left\" id=\"label_249\" for=\"input_249\"> If \"Other\", please explain: <\/label>\n <div id=\"cid_249\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_249\" name=\"q249_ifother249\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_250\">\n <label class=\"form-label-left\" id=\"label_250\" for=\"input_250\"> If you are away for an extended period (overnight or longer), where will the dog be left? Check all that apply. <\/label>\n <div id=\"cid_250\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_250_0\" name=\"q250_ifYou250[]\" value=\"At home (dog sitter)\" \/>\n <label for=\"input_250_0\"> At home (dog sitter) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_250_1\" name=\"q250_ifYou250[]\" value=\"With friends \/ family\" \/>\n <label for=\"input_250_1\"> With friends \/ family <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_250_2\" name=\"q250_ifYou250[]\" value=\"At a kennel \/ day care\" \/>\n <label for=\"input_250_2\"> At a kennel \/ day care <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_250_3\" name=\"q250_ifYou250[]\" value=\"My dog comes with me\" \/>\n <label for=\"input_250_3\"> My dog comes with me <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_250_4\" name=\"q250_ifYou250[]\" value=\"Loose in house\" \/>\n <label for=\"input_250_4\"> Loose in house <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_250_5\" name=\"q250_ifYou250[]\" value=\"Other\" \/>\n <label for=\"input_250_5\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_251\">\n <label class=\"form-label-left\" id=\"label_251\" for=\"input_251\"> If \"Other\", please explain: <\/label>\n <div id=\"cid_251\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_251\" name=\"q251_ifother251\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_252\">\n <label class=\"form-label-left\" id=\"label_252\" for=\"input_252\">\n Will you allow your dog to run loose outside?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_252\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_252_0\" name=\"q252_willYou\" value=\"Yes\" \/>\n <label for=\"input_252_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_252_1\" name=\"q252_willYou\" value=\"No\" \/>\n <label for=\"input_252_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_254\">\n <label class=\"form-label-left\" id=\"label_254\" for=\"input_254\"> If \"Yes\", please explain when, why and for how long: <\/label>\n <div id=\"cid_254\" class=\"form-input\">\n <textarea id=\"input_254\" class=\"form-textarea\" name=\"q254_ifyes254\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_255\">\n <label class=\"form-label-left\" id=\"label_255\" for=\"input_255\"> Will the dog be tied out on a run, line or trolley at any time? <\/label>\n <div id=\"cid_255\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_255_0\" name=\"q255_willThe\" value=\"Yes\" \/>\n <label for=\"input_255_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_255_1\" name=\"q255_willThe\" value=\"No\" \/>\n <label for=\"input_255_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_256\">\n <label class=\"form-label-left\" id=\"label_256\" for=\"input_256\"> If \"Yes\", please explain when, why and for how long: <\/label>\n <div id=\"cid_256\" class=\"form-input\">\n <textarea id=\"input_256\" class=\"form-textarea\" name=\"q256_ifyes256\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_263\">\n <label class=\"form-label-left\" id=\"label_263\" for=\"input_263\"> What do you see as normal veterinary requirements for an average dog? Please give details of vaccines \/ preventative medicine as well as cost estimates of yearly routine vet care: <\/label>\n <div id=\"cid_263\" class=\"form-input\">\n <textarea id=\"input_263\" class=\"form-textarea\" name=\"q263_whatDo\" cols=\"30\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_264\">\n <label class=\"form-label-left\" id=\"label_264\" for=\"input_264\">\n Please describe a typical day in the life of your dog (from waking up to bedtime). This information helps us make the best match for you and your family:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_264\" class=\"form-input\">\n <textarea id=\"input_264\" class=\"form-textarea validate[required]\" name=\"q264_pleaseDescribe264\" cols=\"30\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_262\">\n <label class=\"form-label-left\" id=\"label_262\" for=\"input_262\">\n Which type(s) of dog collars do you plan on using with your dog? (check all that apply)<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_262\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_262_0\" name=\"q262_whichTypes[]\" value=\"Prong Collar\" \/>\n <label for=\"input_262_0\"> Prong Collar <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_262_1\" name=\"q262_whichTypes[]\" value=\"Shock Collar (e-collar)\" \/>\n <label for=\"input_262_1\"> Shock Collar (e-collar) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_262_2\" name=\"q262_whichTypes[]\" value=\"Choke Chain\" \/>\n <label for=\"input_262_2\"> Choke Chain <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_262_3\" name=\"q262_whichTypes[]\" value=\"Standard Buckle\" \/>\n <label for=\"input_262_3\"> Standard Buckle <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_262_4\" name=\"q262_whichTypes[]\" value=\"Martingale\" \/>\n <label for=\"input_262_4\"> Martingale <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_262_5\" name=\"q262_whichTypes[]\" value=\"No Collar\" \/>\n <label for=\"input_262_5\"> No Collar <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_288\">\n <label class=\"form-label-left\" id=\"label_288\" for=\"input_288\">\n Will you be enrolling your dog in an obedience\/ training class?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_288\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_288_0\" name=\"q288_willYou288\" value=\"Yes\" \/>\n <label for=\"input_288_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_288_1\" name=\"q288_willYou288\" value=\"No\" \/>\n <label for=\"input_288_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_288_2\" name=\"q288_willYou288\" value=\"Depends on the dog\" \/>\n <label for=\"input_288_2\"> Depends on the dog <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_259\">\n <label class=\"form-label-left\" id=\"label_259\" for=\"input_259\"> When teaching commands and obedience, which methods do you employ, if any? (check all that apply) <\/label>\n <div id=\"cid_259\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_259_0\" name=\"q259_whenTeaching[]\" value=\"Treats\" \/>\n <label for=\"input_259_0\"> Treats <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_259_1\" name=\"q259_whenTeaching[]\" value=\"Verbal Praise\" \/>\n <label for=\"input_259_1\"> Verbal Praise <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_259_2\" name=\"q259_whenTeaching[]\" value=\"Verbal Warnings\" \/>\n <label for=\"input_259_2\"> Verbal Warnings <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_259_3\" name=\"q259_whenTeaching[]\" value=\"Leash Jerk \/ Collar Pop\" \/>\n <label for=\"input_259_3\"> Leash Jerk \/ Collar Pop <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_259_4\" name=\"q259_whenTeaching[]\" value=\"Aversions (scruff shakes, alpha-rolls, cuffing\/hitting)\" \/>\n <label for=\"input_259_4\"> Aversions (scruff shakes, alpha-rolls, cuffing\/hitting) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_281\">\n <div id=\"cid_281\" class=\"form-input-wide\">\n <div id=\"text_281\" class=\"form-html\">\n Please describe how you would train your dog:\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_285\">\n <label class=\"form-label-left\" id=\"label_285\" for=\"input_285\">\n ... to be housebroken:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_285\" class=\"form-input\">\n <textarea id=\"input_285\" class=\"form-textarea validate[required]\" name=\"q285_To\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_96\">\n <label class=\"form-label-left\" id=\"label_96\" for=\"input_96\">\n ...not to jump up when greeting people:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_96\" class=\"form-input\">\n <textarea id=\"input_96\" class=\"form-textarea validate[required]\" name=\"q96_notTo\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_282\">\n <label class=\"form-label-left\" id=\"label_282\" for=\"input_282\">\n ...to stop nipping:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_282\" class=\"form-input\">\n <textarea id=\"input_282\" class=\"form-textarea validate[required]\" name=\"q282_toStop\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_283\">\n <label class=\"form-label-left\" id=\"label_283\" for=\"input_283\">\n ...to stop stealing food from table\/counter tops:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_283\" class=\"form-input\">\n <textarea id=\"input_283\" class=\"form-textarea validate[required]\" name=\"q283_toStop283\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_284\">\n <label class=\"form-label-left\" id=\"label_284\" for=\"input_284\">\n ...to stop barking excessively:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_284\" class=\"form-input\">\n <textarea id=\"input_284\" class=\"form-textarea validate[required]\" name=\"q284_toStop284\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_286\">\n <label class=\"form-label-left\" id=\"label_286\" for=\"input_286\">\n ...to react positively to strangers\/other dogs:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_286\" class=\"form-input\">\n <textarea id=\"input_286\" class=\"form-textarea validate[required]\" name=\"q286_toReact\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_279\">\n <label class=\"form-label-left\" id=\"label_279\" for=\"input_279\">\n Based on the training methods you employ, please indicate which philosophy describes you best:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_279\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_279_0\" name=\"q279_basedOn\" value=\"I am new to dogs\/dog training, and open to suggestions.\" \/>\n <label for=\"input_279_0\"> I am new to dogs\/dog training, and open to suggestions. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_279_1\" name=\"q279_basedOn\" value=\"My training system isn't as effective as I'd like - please help!\" \/>\n <label for=\"input_279_1\"> My training system isn't as effective as I'd like - please help! <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_279_2\" name=\"q279_basedOn\" value=\"My training system seems to be working well, but I am open to alternative suggestions.\" \/>\n <label for=\"input_279_2\"> My training system seems to be working well, but I am open to alternative suggestions. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_279_3\" name=\"q279_basedOn\" value=\"I've had success with my current training system and unlikely to change how I do things without a compelling reason.\" \/>\n <label for=\"input_279_3\"> I've had success with my current training system and unlikely to change how I do things without a compelling reason. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_279_4\" name=\"q279_basedOn\" value=\"I am knowledgeable on the variety of current training styles, and know my methods to be the most successful and effective.\" \/>\n <label for=\"input_279_4\"> I am knowledgeable on the variety of current training styles, and know my methods to be the most successful and effective. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_279_5\" name=\"q279_basedOn\" value=\"None of the above.\" \/>\n <label for=\"input_279_5\"> None of the above. <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_290\">\n <label class=\"form-label-left\" id=\"label_290\" for=\"input_290\"> If \"None of the above\" and for additional comments: <\/label>\n <div id=\"cid_290\" class=\"form-input\">\n <textarea id=\"input_290\" class=\"form-textarea\" name=\"q290_ifnone\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_265\">\n <label class=\"form-label-left\" id=\"label_265\" for=\"input_265\"> Do you have plans for your dog's care in the event of a catastrophic incident (e.g. death, long-term illness, temporary incapacitation, etc.)? <\/label>\n <div id=\"cid_265\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_265_0\" name=\"q265_doYou265\" value=\"Yes\" \/>\n <label for=\"input_265_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_265_1\" name=\"q265_doYou265\" value=\"No\" \/>\n <label for=\"input_265_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_265_2\" name=\"q265_doYou265\" value=\"Hadn't considered it\" \/>\n <label for=\"input_265_2\"> Hadn't considered it <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_267\">\n <label class=\"form-label-left\" id=\"label_267\" for=\"input_267\"> Your turn! Please add any information about yourself that you think would be useful in helping us match you with the right dog. <\/label>\n <div id=\"cid_267\" class=\"form-input\">\n <textarea id=\"input_267\" class=\"form-textarea\" name=\"q267_yourTurn\" cols=\"30\" rows=\"7\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_268\">\n <label class=\"form-label-left\" id=\"label_268\" for=\"input_268\"> Are you willing to have one of our Volunteers come to your house for a Home Visit? <\/label>\n <div id=\"cid_268\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_268_0\" name=\"q268_areYou268\" value=\"Yes\" \/>\n <label for=\"input_268_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_268_1\" name=\"q268_areYou268\" value=\"No\" \/>\n <label for=\"input_268_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_269\">\n <div id=\"cid_269\" class=\"form-input-wide\">\n <div id=\"text_269\" class=\"form-html\">\n By submitting this application, I attest to the truthfulness of my answers. I understand that falsification or fabrication of answers will be grounds to disallow an adoption of a Border Collie from New England Border Collie Rescue, Inc.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_270\">\n <label class=\"form-label-left\" id=\"label_270\" for=\"input_270\">\n Click here to agree<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_270\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_270_0\" name=\"q270_clickHere\" value=\"I understand that New England Border Collie Rescue, Inc. has the right to refuse any applicant for any reason.\" \/>\n <label for=\"input_270_0\"> I understand that New England Border Collie Rescue, Inc. has the right to refuse any applicant for any reason. <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_271\">\n <label class=\"form-label-left\" id=\"label_271\" for=\"input_271\">\n Please verify the text in the image:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_271\" class=\"form-input\">\n <div class=\"form-captcha\">\n <label for=\"input_271\"> <img alt=\"Captcha - Reload if it's not displayed\" id=\"input_271_captcha\" class=\"form-captcha-image\" style=\"background:url(http:\/\/www.jotform.com\/images\/loader-big.gif) no-repeat center;\" src=\"http:\/\/www.jotform.com\/images\/blank.gif\" width=\"150\" height=\"41\" \/> <\/label>\n <div style=\"white-space:nowrap;\">\n <input type=\"text\" id=\"input_271\" name=\"captcha\" style=\"width:130px;\" \/>\n <img src=\"http:\/\/www.jotform.com\/images\/reload.png\" alt=\"Reload\" align=\"absmiddle\" style=\"cursor:pointer\" onclick=\"JotForm.reloadCaptcha('input_271');\" \/>\n <input type=\"hidden\" name=\"captcha_id\" id=\"input_271_captcha_id\" value=\"0\">\n <\/div>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_291\">\n <div id=\"cid_291\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_291\" type=\"submit\" class=\"form-submit-button\">\n Submit Form\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <li style=\"display:none\">\n Should be Empty:\n <input type=\"text\" name=\"website\" value=\"\" \/>\n <\/li>\n <\/ul>\n <\/div>\n <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"82171856201\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"82171856201-82171856201\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");