{"id":610,"date":"2020-07-15T22:02:21","date_gmt":"2020-07-15T22:02:21","guid":{"rendered":"http:\/\/animalservices.venturacounty.gov\/?page_id=610"},"modified":"2025-11-12T10:29:19","modified_gmt":"2025-11-12T17:29:19","slug":"report-animal-abuse-neglect","status":"publish","type":"page","link":"https:\/\/animalservices.venturacounty.gov\/fr\/report-animal-abuse-neglect\/","title":{"rendered":"Report Animal Abuse\/Neglect"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"610\" class=\"elementor elementor-610\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b693825 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b693825\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5dce06f\" data-id=\"5dce06f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5d4b244 elementor-widget elementor-widget-text-editor\" data-id=\"5d4b244\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><a href=\"https:\/\/leginfo.legislature.ca.gov\/faces\/codes_displaySection.xhtml?lawCode=PEN&amp;sectionNum=597\">Animal cruelty<\/a> encompasses behavior harmful to animals ranging from neglect to physical abuse and malicious killing.\u00a0 Most cruelty investigations often reveal unintentional neglect, rather than intentional abuse. \u00a0Such situations can be resolved through education. \u00a0Intentional cruelty or abuse is knowingly depriving an animal of food, water, shelter or veterinary care.\u00a0 Intention abuse is maliciously torturing, maiming, mutilating, or killing of an animal.\u00a0 Use the form below to report\u00a0a case of animal <strong>abuse<\/strong>\u00a0or <strong>neglect<\/strong>. \u00a0You can submit\u00a0the report anonymously if you wish. \u00a0If you prefer to mail-in a paper report, please print this page, complete it to the best of your ability, and mail to:<\/p><p style=\"padding-left: 40px;\">Ventura County Animal Services<br \/>Attn: \u00a0Humane Officer<br \/>600 Aviation Drive<br \/>Camarillo, CA 93010<\/p><p>Please note: \u00a0Animal cruelty <strong>does not<\/strong> include disturbances such as barking dogs or loud cats. \u00a0For these complaints, <a href=\"https:\/\/animalservices.venturacounty.gov\/nuisance-complaints\/\">please click here to complete a nuisance complaint form<\/a>.\u00a0 \u00a0<span style=\"color: #eb0000;\">If you are witnessing an emergency situation and an animal\u2019s life is in immediate danger, please call <\/span><strong style=\"color: #eb0000;\">(805) 388-4341<\/strong><span style=\"color: #eb0000;\">.<\/span><\/p><p>Thank you for caring for the welfare of animals in our community!<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1e1477d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1e1477d\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-48c59b1\" data-id=\"48c59b1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f597314 elementor-widget elementor-widget-shortcode\" data-id=\"f597314\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_5' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">REPORT ANIMAL ABUSE\/NEGLECT<\/h2>\n                            <p class='gform_description'>Please complete this form to the best of your ability.  An incomplete form may lead to the inability to respond to this issue in a timely manner.  If you choose to include your name and contact information, please know that it will remain anonymous.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/fr\/wp-json\/wp\/v2\/pages\/610' data-formid='5' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Lf7QbYrAAAAAKcQPdQmWu4270fzpeXdgYeK50tg' data-tabindex='0'><input id=\"input_baf6c8a8d9651f63d56494042fa96ab9\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_baf6c8a8d9651f63d56494042fa96ab9\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_1\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_1'>How many animals are involved?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_1' id='input_5_1' type='number' step='any' min='1' max='100' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_1\" \/><div class='gfield_description instruction ' id='gfield_instruction_5_1'>Veuillez saisir un nombre entre <strong>1<\/strong> et <strong>100<\/strong>.<\/div><\/div><\/div><div id=\"field_5_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-seven-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_2'>List the species, breed, color and approximate age(s) of animals involved.<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_5_2' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_2\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_2'>EXAMPLE:  Dog, terrier, brown and white, 5 years old.<\/div><\/div><fieldset id=\"field_5_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Duration of incident:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_3'>\n\t\t\t<div class='gchoice gchoice_5_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='A one-time incident.'  id='choice_5_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_3_0' id='label_5_3_0' class='gform-field-label gform-field-label--type-inline'>A one-time incident.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Has occurred more than once.'  id='choice_5_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_3_1' id='label_5_3_1' class='gform-field-label gform-field-label--type-inline'>Has occurred more than once.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='This is an ongoing incident.'  id='choice_5_3_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_3_2' id='label_5_3_2' class='gform-field-label gform-field-label--type-inline'>This is an ongoing incident.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_3_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Other'  id='choice_5_3_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_3_3' id='label_5_3_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-seven-twelfths field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_4'>Indicate other...<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_5_4' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_6\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Time of Incident<\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_5_6'>\n                            <input type='number' name='input_6[]' id='input_5_6_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='false'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_5_6_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_6[]' id='input_5_6_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_5_6_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n                                \n                                <select name='input_6[]' id='input_5_6_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select> \n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_5_6_3'>AM\/PM<\/label>                                \n                           <\/div>\n                    <\/div><\/fieldset><fieldset id=\"field_5_5\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Incident<\/legend><div id='input_5_5' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_5_5_1_container'>\n                                            <input type='number' maxlength='2' name='input_5[]' id='input_5_5_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_5_5_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_5_5_2_container'>\n                                            <input type='number' maxlength='2' name='input_5[]' id='input_5_5_2' value=''   aria-required='false'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                            <label for='input_5_5_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_5_5_3_container'>\n                                            <input type='number' maxlength='4' name='input_5[]' id='input_5_5_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                            <label for='input_5_5_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_5_18\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address of incident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_18' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_18_1_container' >\n                                        <input type='text' name='input_18.1' id='input_5_18_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_18_1' id='input_5_18_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_18_2_container' >\n                                        <input type='text' name='input_18.2' id='input_5_18_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_18_2' id='input_5_18_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_18_3_container' >\n                                    <input type='text' name='input_18.3' id='input_5_18_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_18_3' id='input_5_18_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_18_4_container' >\n                                        <select name='input_18.4' id='input_5_18_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='Californie' >Californie<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District de Columbia' >District de Columbia<\/option><option value='Floride' >Floride<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='Guam' >Guam<\/option><option value='Hawa\u00ef' >Hawa\u00ef<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiane' >Louisiane<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='Nouveau-Mexique' >Nouveau-Mexique<\/option><option value='New York' >New York<\/option><option value='Caroline du Nord' >Caroline du Nord<\/option><option value='Dakota du Nord' >Dakota du Nord<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvanie' >Pennsylvanie<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='Caroline du Sud' >Caroline du Sud<\/option><option value='Dakota du Sud' >Dakota du Sud<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='Vermont' >Vermont<\/option><option value='Virginie' >Virginie<\/option><option value='Washington' >Washington<\/option><option value='Virginie-Occidentale' >Virginie-Occidentale<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Forces arm\u00e9es des Am\u00e9riques' >Forces arm\u00e9es des Am\u00e9riques<\/option><option value='Forces arm\u00e9es en Europe' >Forces arm\u00e9es en Europe<\/option><option value='Forces arm\u00e9es du Pacifique' >Forces arm\u00e9es du Pacifique<\/option><\/select>\n                                        <label for='input_5_18_4' id='input_5_18_4_label' class='gform-field-label gform-field-label--type-sub '>D\u00e9partement<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_18_5_container' >\n                                    <input type='text' name='input_18.5' id='input_5_18_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_18_5' id='input_5_18_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_18.6' id='input_5_18_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_8\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_8'>Indicate cross street of incident if a specific address cannot be provided.<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_5_8' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_8\"  placeholder='First Street and Main Street'  aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_8'>Pleas be as specific as possible when describing the abuse\/neglect that you have observed.<\/div><\/div><div id=\"field_5_20\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_20'>Details of abuse or neglect witnessed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_20' id='input_5_20' class='textarea large'  aria-describedby=\"gfield_description_5_20\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_5_20'>Please be as specific as possible while describing the abuse\/neglect that you have observed.<\/div><\/div><div id=\"field_5_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_21'>Suspect name(s), if known:<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_5_21' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_21\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_21'>Separate names with a comma.<\/div><\/div><div id=\"field_5_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_22'>Physical description of suspect.<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_5_22' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_22\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_22'>(Gender.  Age.  Height.  Hair color.  Ethnicity.  Facial hair.  Tattoos, etc.)<\/div><\/div><div id=\"field_5_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_23'>Threat level of suspect.<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_5_23' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_23\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_23'>To help ensure officer safety, please describe anything potentially dangerous.  (i.e. violent nature, weapons, drugs, gang affiliation, etc.)<\/div><\/div><div id=\"field_5_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_24'>General location of animal(s) on property.<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_5_24' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_24\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_24'>(i.e. Indoors, patio, balcony, garage, backyard)<\/div><\/div><fieldset id=\"field_5_25\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Check all that apply:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_25'><div class='gchoice gchoice_5_25_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.1' type='checkbox'  value='Animal(s) don&#039;t have access to shelter (i.e. house, patio cover, dog house, tarp, etc.)'  id='choice_5_25_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_25_1' id='label_5_25_1' class='gform-field-label gform-field-label--type-inline'>Animal(s) don't have access to shelter (i.e. house, patio cover, dog house, tarp, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_25_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.2' type='checkbox'  value='Animal(s) are confined most\/all of the time (i.e. chain, cage, tether, etc.)'  id='choice_5_25_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_25_2' id='label_5_25_2' class='gform-field-label gform-field-label--type-inline'>Animal(s) are confined most\/all of the time (i.e. chain, cage, tether, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_25_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.3' type='checkbox'  value='Animal(s) have no\/limited access to fresh water.'  id='choice_5_25_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_25_3' id='label_5_25_3' class='gform-field-label gform-field-label--type-inline'>Animal(s) have no\/limited access to fresh water.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_25_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.4' type='checkbox'  value='Animal(s) are not fed regularly.'  id='choice_5_25_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_25_4' id='label_5_25_4' class='gform-field-label gform-field-label--type-inline'>Animal(s) are not fed regularly.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_25_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.5' type='checkbox'  value='Animal(s) live in unsanitary conditions (i.e. waste is not picked up, etc.)'  id='choice_5_25_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_25_5' id='label_5_25_5' class='gform-field-label gform-field-label--type-inline'>Animal(s) live in unsanitary conditions (i.e. waste is not picked up, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_25_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.6' type='checkbox'  value='Animal(s) coat\/skin appears in poor condition.'  id='choice_5_25_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_25_6' id='label_5_25_6' class='gform-field-label gform-field-label--type-inline'>Animal(s) coat\/skin appears in poor condition.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_25_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.7' type='checkbox'  value='Animal(s) physical condition is generally poor.'  id='choice_5_25_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_25_7' id='label_5_25_7' class='gform-field-label gform-field-label--type-inline'>Animal(s) physical condition is generally poor.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_25_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.8' type='checkbox'  value='Animal(s) have physical injuries (i.e. limping, scratches, bleeding, etc.)'  id='choice_5_25_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_25_8' id='label_5_25_8' class='gform-field-label gform-field-label--type-inline'>Animal(s) have physical injuries (i.e. limping, scratches, bleeding, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_26\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_26'>Any additional information we should know:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_5_26' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_33\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_5_27\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your name (optional)<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_27'>\n                            \n                            <span id='input_5_27_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.3' id='input_5_27_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_27_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_27_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.6' id='input_5_27_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_27_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><div class='gfield_description' id='gfield_description_5_27'>All contact information you provide will remain anonymous.<\/div><\/fieldset><div id=\"field_5_28\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_28'>Your phone number (optional)<\/label><div class='ginput_container ginput_container_phone'><input name='input_28' id='input_5_28' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_29\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_29'>Your email address (optional)<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_29' id='input_5_29' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_5_30\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your address (optional)<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_5_30' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_30_1_container' >\n                                        <input type='text' name='input_30.1' id='input_5_30_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_30_1' id='input_5_30_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_30_2_container' >\n                                        <input type='text' name='input_30.2' id='input_5_30_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_30_2' id='input_5_30_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_30_3_container' >\n                                    <input type='text' name='input_30.3' id='input_5_30_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_30_3' id='input_5_30_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_30_4_container' >\n                                        <input type='text' name='input_30.4' id='input_5_30_4' value=''      aria-required='false'    \/>\n                                        <label for='input_5_30_4' id='input_5_30_4_label' class='gform-field-label gform-field-label--type-sub '>\u00c9tat\/Province\/R\u00e9gion<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_30_5_container' >\n                                    <input type='text' name='input_30.5' id='input_5_30_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_30_5' id='input_5_30_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_5_30_6_container' >\n                                        <select name='input_30.6' id='input_5_30_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Afrique du Sud' >Afrique du Sud<\/option><option value='Albanie' >Albanie<\/option><option value='Alg\u00e9rie' >Alg\u00e9rie<\/option><option value='Allemagne' >Allemagne<\/option><option value='Andorre' >Andorre<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctique' >Antarctique<\/option><option value='Antigua-et-Barbuda' >Antigua-et-Barbuda<\/option><option value='Arabie Saoudite' >Arabie Saoudite<\/option><option value='Argentine' >Argentine<\/option><option value='Arm\u00e9nie' >Arm\u00e9nie<\/option><option value='Aruba' >Aruba<\/option><option value='Australie' >Australie<\/option><option value='Autriche' >Autriche<\/option><option value='Azerba\u00efdjan' >Azerba\u00efdjan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahre\u00efn<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Belarus' >Belarus<\/option><option value='Belgique' >Belgique<\/option><option value='Belize' >Belize<\/option><option value='Bermudes' >Bermudes<\/option><option value='Bhoutan' >Bhoutan<\/option><option value='Bolivie' >Bolivie<\/option><option value='Bonaire, Saint-Eustache et Saba' >Bonaire, Saint-Eustache et Saba<\/option><option value='Bosnie-Herz\u00e9govine' >Bosnie-Herz\u00e9govine<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Br\u00e9sil' >Br\u00e9sil<\/option><option value='Bulgarie' >Bulgarie<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9nin' >B\u00e9nin<\/option><option value='Cambodge' >Cambodge<\/option><option value='Cameroun' >Cameroun<\/option><option value='Canada' >Canada<\/option><option value='Cap-Vert' >Cap-Vert<\/option><option value='Chili' >Chili<\/option><option value='Chine' >Chine<\/option><option value='Chypre' >Chypre<\/option><option value='Colombie' >Colombie<\/option><option value='Comores' >Comores<\/option><option value='Congo' >Congo<\/option><option value='Cor\u00e9e (R\u00e9publique de)' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatie<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d\u2019Ivoire' >C\u00f4te d\u2019Ivoire<\/option><option value='Danemark' >Danemark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominique<\/option><option value='Espagne' >Espagne<\/option><option value='Estonie' >Estonie<\/option><option value='Eswatini' >Eswatini<\/option><option value='Fidji' >Fidji<\/option><option value='Finlande' >Finlande<\/option><option value='France' >France<\/option><option value='F\u00e9d\u00e9ration Russe' >F\u00e9d\u00e9ration Russe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambie<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenade' >Grenade<\/option><option value='Groenland' >Groenland<\/option><option value='Gr\u00e8ce' >Gr\u00e8ce<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guin\u00e9e' >Guin\u00e9e<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Guin\u00e9e \u00e9quatoriale<\/option><option value='Guin\u00e9e-Bissau' >Guin\u00e9e-Bissau<\/option><option value='Guyane' >Guyane<\/option><option value='Guyane' >Guyane<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='G\u00e9orgie du Sud et \u00celes Sandwich du Sud' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongrie' >Hongrie<\/option><option value='Inde' >Inde<\/option><option value='Indon\u00e9sie' >Indon\u00e9sie<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Irlande<\/option><option value='Islande' >Islande<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Italie' >Italie<\/option><option value='Jama\u00efque' >Jama\u00efque<\/option><option value='Japon' >Japon<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanie' >Jordanie<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kirghizistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kowe\u00eft' >Kowe\u00eft<\/option><option value='La Barbade' >La Barbade<\/option><option value='La R\u00e9union' >La R\u00e9union<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Lettonie<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libye<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lituanie<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Mac\u00e9doine du Nord' >Mac\u00e9doine du Nord<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaisie<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malte<\/option><option value='Maroc' >Maroc<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritanie' >Mauritanie<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexique' >Mexique<\/option><option value='Micron\u00e9sie' >Micron\u00e9sie<\/option><option value='Moldavie' >Moldavie<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolie<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mont\u00e9n\u00e9gro' >Mont\u00e9n\u00e9gro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibie<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nig\u00e9ria<\/option><option value='Niu\u00e9' >Niu\u00e9<\/option><option value='Norv\u00e8ge' >Norv\u00e8ge<\/option><option value='Nouvelle-Cal\u00e9donie' >Nouvelle-Cal\u00e9donie<\/option><option value='Nouvelle-Z\u00e9lande' >Nouvelle-Z\u00e9lande<\/option><option value='N\u00e9pal' >N\u00e9pal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Ouzb\u00e9kistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Pays-Bas<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Pologne<\/option><option value='Polyn\u00e9sie fran\u00e7aise' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >P\u00e9rou<\/option><option value='Qatar' >Qatar<\/option><option value='Roumanie' >Roumanie<\/option><option value='Royaume-Uni' >Royaume-Uni<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9publique Dominicaine' >R\u00e9publique Dominicaine<\/option><option value='R\u00e9publique Tch\u00e8que' >R\u00e9publique Tch\u00e8que<\/option><option value='R\u00e9publique arabe syrienne' >R\u00e9publique arabe syrienne<\/option><option value='R\u00e9publique centrafricaine' >R\u00e9publique centrafricaine<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='Sahara occidental' >Sahara occidental<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre et Miquelon' >Saint Pierre et Miquelon<\/option><option value='Saint-Christophe-et-Nevis' >Saint-Christophe-et-Nevis<\/option><option value='Saint-Marin' >Saint-Marin<\/option><option value='Saint-Si\u00e8ge' >Saint-Si\u00e8ge<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint-Vincent-et-les Grenadines<\/option><option value='Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='Sainte-Lucie' >Sainte-Lucie<\/option><option value='Salvador' >Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tom\u00e9 et Principe<\/option><option value='Serbie' >Serbie<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapour<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovaquie' >Slovaquie<\/option><option value='Slov\u00e9nie' >Slov\u00e9nie<\/option><option value='Somalie' >Somalie<\/option><option value='Soudan' >Soudan<\/option><option value='Soudan du Sud' >Soudan du Sud<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Suisse<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Su\u00e8de<\/option><option value='S\u00e9n\u00e9gal' >S\u00e9n\u00e9gal<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie (R\u00e9publique-Unie de)' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='Ta\u00efwan' >Ta\u00efwan<\/option><option value='Tchad' >Tchad<\/option><option value='Terres Australes Fran\u00e7aises' >Terres Australes Fran\u00e7aises<\/option><option value='Territoire britannique de l\u2019oc\u00e9an Indien' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='Tha\u00eflande' >Tha\u00eflande<\/option><option value='Timor oriental' >Timor oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinit\u00e9 et Tobago<\/option><option value='Tunisie' >Tunisie<\/option><option value='Turkm\u00e9nistan' >Turkm\u00e9nistan<\/option><option value='Turquie' >Turquie<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis et Futuna' >Wallis et Futuna<\/option><option value='Y\u00e9men' >Y\u00e9men<\/option><option value='Zambie' >Zambie<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c9gypte' >\u00c9gypte<\/option><option value='\u00c9mirats arabes unis' >\u00c9mirats arabes unis<\/option><option value='\u00c9quateur' >\u00c9quateur<\/option><option value='\u00c9rythr\u00e9e' >\u00c9rythr\u00e9e<\/option><option value='\u00c9tat palestinien' >\u00c9tat palestinien<\/option><option value='\u00c9tats-Unis' >\u00c9tats-Unis<\/option><option value='\u00c9thiopie' >\u00c9thiopie<\/option><option value='\u00cele Bouvet' >\u00cele Bouvet<\/option><option value='\u00cele Christmas' >\u00cele Christmas<\/option><option value='\u00cele Maurice' >\u00cele Maurice<\/option><option value='\u00cele Norfolk' >\u00cele Norfolk<\/option><option value='\u00cele de Man' >\u00cele de Man<\/option><option value='\u00celes Cayman' >\u00celes Cayman<\/option><option value='\u00celes Cocos' >\u00celes Cocos<\/option><option value='\u00celes Cook' >\u00celes Cook<\/option><option value='\u00celes Falkland' >\u00celes Falkland<\/option><option value='\u00celes F\u00e9ro\u00e9' >\u00celes F\u00e9ro\u00e9<\/option><option value='\u00celes Heard et McDonald' >\u00celes Heard et McDonald<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='\u00celes Marshall' >\u00celes Marshall<\/option><option value='\u00celes Pitcairn' >\u00celes Pitcairn<\/option><option value='\u00celes Salomon' >\u00celes Salomon<\/option><option value='\u00celes Turques et Ca\u00efques' >\u00celes Turques et Ca\u00efques<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='\u00celes Vierges britanniques' >\u00celes Vierges britanniques<\/option><option value='\u00celes de Svalbard et Jan Mayen' >\u00celes de Svalbard et Jan Mayen<\/option><option value='\u00celes mineures am\u00e9ricaines' >\u00celes mineures am\u00e9ricaines<\/option><option value='\u00celes \u00c5land' >\u00celes \u00c5land<\/option><\/select>\n                                        <label for='input_5_30_6' id='input_5_30_6_label' class='gform-field-label gform-field-label--type-sub '>Pays<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_31\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_31'>Upload photo\/video of observed abuse or neglect.<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_31' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_31&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_31&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_31&quot;,&quot;filelist&quot;:&quot;gform_preview_5_31&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/animalservices.venturacounty.gov\\\/?gf_page=438a9c39c37e9cf&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/animalservices.venturacounty.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/animalservices.venturacounty.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers 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files to be uploaded.  Avoid cropping or manipulating photos or video.  We have the ability to enhance photos and video clips.<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_5' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit Report'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_5' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_5' id='gform_theme_5' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_5' id='gform_style_settings_5' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_5' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='5' \/>\n            \n            <input type='hidden' 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elementor-element-e931777 elementor-widget elementor-widget-heading\" data-id=\"e931777\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Animal Abuse or Neglect Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fdbe5b5 elementor-widget elementor-widget-text-editor\" data-id=\"fdbe5b5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Please complete this form to the best of your ability. &nbsp;An incomplete form may lead to the inability to respond to this issue in a timely manner. &nbsp;If you choose to include your name and contact information, please know that it will remain anonymous.&nbsp; At the end of this form, we ask for you to upload photos or video as evidence of abuse or neglect.&nbsp; Please do not put yourself in harm&#8217;s way to capture footage.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9a425cf elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"9a425cf\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Report Animal Abuse\/Neglect\" aria-label=\"Report Animal Abuse\/Neglect\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"610\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"9a425cf\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Report Animal Abuse\/Neglect - Ventura County Animal Services\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"610\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-name elementor-col-25 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow many animals are involved?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Number\" required=\"required\" min=\"\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d635aba elementor-col-75 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d635aba\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tList the species, breed, color and approximate age(s) of animals involved.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d635aba]\" id=\"form-field-field_d635aba\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"EXAMPLE:  Dog, terrier, brown and white, 5 years old.\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_ad4343d elementor-col-25 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ad4343d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDuration of incident:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\" A one-time incident.\" id=\"form-field-field_ad4343d-0\" name=\"form_fields[field_ad4343d]\" required=\"required\"> <label for=\"form-field-field_ad4343d-0\"> A one-time incident.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Has occurred more than once.\" id=\"form-field-field_ad4343d-1\" name=\"form_fields[field_ad4343d]\" required=\"required\"> <label for=\"form-field-field_ad4343d-1\">Has occurred more than once.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"This is an ongoing incident.\" id=\"form-field-field_ad4343d-2\" name=\"form_fields[field_ad4343d]\" required=\"required\"> <label for=\"form-field-field_ad4343d-2\">This is an ongoing incident.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b08442e elementor-col-75 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b08442e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate and time of incident: (or indicate times of day this incident occurs on)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b08442e]\" id=\"form-field-field_b08442e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3fad322 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3fad322\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLocation of incident:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3fad322]\" id=\"form-field-field_3fad322\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Address, including city. Indicate cross street if needed.\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_54f1281 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_54f1281\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDetails of incident.  Please be as specific as possible while describing the abuse\/neglect that you have observed.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_54f1281]\" id=\"form-field-field_54f1281\" rows=\"9\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0ab4940 elementor-col-75\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0ab4940\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSuspect name(s), if known:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0ab4940]\" id=\"form-field-field_0ab4940\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_12306ef elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_12306ef\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSuspect physical description.  (Gender. Age. Height. Hair color. Ethnicity. Facial hair. Tattoos, etc.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_12306ef]\" id=\"form-field-field_12306ef\" rows=\"9\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_086b42f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_086b42f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSuspect threat level.   To ensure officer safety, please describe anything potentially dangerous. (i.e. violent nature, weapons, drugs, gang affiliation, etc.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_086b42f]\" id=\"form-field-field_086b42f\" rows=\"5\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_536769e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_536769e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSuspect\u2019s address (include apartment number and cross street if needed)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_536769e]\" id=\"form-field-field_536769e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c923fae elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c923fae\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeneral location of animals on property (i.e. Indoors, patio, balcony, garage, back yard.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c923fae]\" id=\"form-field-field_c923fae\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5a3dc91 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5a3dc91\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVehicle type, color, make\/model.  License plate number if able to see.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5a3dc91]\" id=\"form-field-field_5a3dc91\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_0ec3c41 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0ec3c41\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCheck all that apply:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Animal(s) don\u2019t have access to shelter (i.e. house, patio cover, dog house, tarp.)\" id=\"form-field-field_0ec3c41-0\" name=\"form_fields[field_0ec3c41][]\"> <label for=\"form-field-field_0ec3c41-0\">Animal(s) don\u2019t have access to shelter (i.e. house, patio cover, dog house, tarp.)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Animal(s) are confined most\/all of the time (i.e. chain, cage, tether.)\" id=\"form-field-field_0ec3c41-1\" name=\"form_fields[field_0ec3c41][]\"> <label for=\"form-field-field_0ec3c41-1\">Animal(s) are confined most\/all of the time (i.e. chain, cage, tether.)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Animal(s) have no\/limited access to fresh water.\" id=\"form-field-field_0ec3c41-2\" name=\"form_fields[field_0ec3c41][]\"> <label for=\"form-field-field_0ec3c41-2\">Animal(s) have no\/limited access to fresh water.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Animal(s) are not fed regularly.\" id=\"form-field-field_0ec3c41-3\" name=\"form_fields[field_0ec3c41][]\"> <label for=\"form-field-field_0ec3c41-3\">Animal(s) are not fed regularly.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Animal(s) lives in unsanitary condition. (i.e. waste is not picked up.)\" id=\"form-field-field_0ec3c41-4\" name=\"form_fields[field_0ec3c41][]\"> <label for=\"form-field-field_0ec3c41-4\">Animal(s) lives in unsanitary condition. (i.e. waste is not picked up.)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Animal(s) coat\/skin appears in poor condition.\" id=\"form-field-field_0ec3c41-5\" name=\"form_fields[field_0ec3c41][]\"> <label for=\"form-field-field_0ec3c41-5\">Animal(s) coat\/skin appears in poor condition.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Animal(s) physical condition is generally poor.\" id=\"form-field-field_0ec3c41-6\" name=\"form_fields[field_0ec3c41][]\"> <label for=\"form-field-field_0ec3c41-6\">Animal(s) physical condition is generally poor.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Animal(s) have physical injuries. (i.e., limping, scratches, bleeding.)\" id=\"form-field-field_0ec3c41-7\" name=\"form_fields[field_0ec3c41][]\"> <label for=\"form-field-field_0ec3c41-7\">Animal(s) have physical injuries. (i.e., limping, scratches, bleeding.)<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_f91f469 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f91f469\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAny additional information we should know:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_f91f469]\" id=\"form-field-field_f91f469\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_27fb3f1 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_27fb3f1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYour Name (optional)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_27fb3f1]\" id=\"form-field-field_27fb3f1\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_3cf162e elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3cf162e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYour Phone Number (optional)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_3cf162e]\" id=\"form-field-field_3cf162e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"(805) 555-1212\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_0fde221 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0fde221\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYour Email Address (optional)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_0fde221]\" id=\"form-field-field_0fde221\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Example@gmail.com\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_59fd4a3 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_59fd4a3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYour Address (optional)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_59fd4a3]\" id=\"form-field-field_59fd4a3\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Number and street.\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d44e59e elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d44e59e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d44e59e]\" id=\"form-field-field_d44e59e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_f8d9584 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f8d9584\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tState\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_f8d9584]\" id=\"form-field-field_f8d9584\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"CA\">CA<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_36f7c77 elementor-col-20\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_36f7c77\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZIP Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_36f7c77]\" id=\"form-field-field_36f7c77\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"ZIP Code\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group 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