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  •   Name of the Individual Relationship to You Age
    1.
    2.
    3.
    4.
    5.
  •   Name of Pet Species Type/Breed Sex Spayed/Altered Current Age Owned Since
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    2.
    3.
    4.
    5.
  •   Pet's Name Species Type/Breed Why the pet is no longer with you How did the pet die? If applicable
    1.
    2.
    3.
    5.
  •   Yes No
    Is older (6 yrs +)
    Has been abused
    Is not reliable with children
    Has a physical handicap
    Requires regular medicine
    Requires continued house training
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  • We are seeking your preferences in the following four categories 

    (Please select your preferences)

  •   Male Female Either
    Gender
  •   Red Black & tan Dapple
    Coloring
  •   Smooth Long hair Wire hair
    Coat
  •   Mini Tweenie Standard
    Size
  •    
  • Should be Empty: