Brown & Bonded Contact Form

Please use this form to provide your contact information and indicate which topic(s) from the film you would like to be contacted about.

CONFIDENTIALITY: All data for this study will be collected and stored in a secure online database (Survey Monkey). Your email will only be used for the purposes of contacting you regarding services provided by CARE and will not be shared with others.

Questions about this survey? Contact CARE’s Research and Development team at research@careawo.org

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First name
(Required.)

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Last name (Required.)

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Email
(Required.)

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Which of the following topic(s) would you like to share about? Check all that apply. (Required.)

Barriers to adopting from animal shelters/rescues or denied adoption application

Pet grief and loss

Interactions with animal control

Barriers to accessing veterinary care or pet support services

Other (please specify)

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State
(Required.)

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Zip Code
(Required.)

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OPTIONAL. What is your race and/or ethnic identity? Check all that apply.

African (Kenyan, Nigerian, Zambian, etc.)

Arab (Palestinian, Algerian, Egyptian, etc.)

Black (Afro-Canadian, African American, Afro-British, etc.)

Caribbean (Cuban, Dominican, Jamaican, etc.)

East Asian (Chinese, Japanese, Korean, etc.)

Indigenous People (Native American, Alaska Native, First Nation, Mayan, Inuit, Aboriginal, Native Hawaiian, Maori, etc.)

South American, Central American, Mexican (Hispanic, Latino, Chicano, etc.)

South Asian (Indian, Pakistani, Sri Lankan, etc.)

Southeast Asian (Vietnamese, Cambodian, Filipino, etc.)

West Asian or Middle Eastern (Iranian, Afghan, Lebanese, etc.)

Pacific Islander (Polynesian, Samoan, Tahitian, etc.)

White

Jewish (for persons who identify ethnically as Jewish)

Unknown (for individuals who have been adopted and/or don’t know their racial and ethnic heritage)

Prefer not to answer

Other (please describe)

Thank you for completing our Brown and Bonded contact form!

You can follow us on Instagram at @careforequity or donate to CARE using PayPal here: https://careawo.org/donate/

100% of survey complete.

Brown & Bonded Contact Form

Question Title

* First name (Required.)

Question Title

* Last name (Required.)

Question Title

* Email (Required.)

Question Title

* Which of the following topic(s) would you like to share about? Check all that apply. (Required.)

Question Title

* State (Required.)

Question Title

* Zip Code (Required.)

Question Title

* OPTIONAL. What is your race and/or ethnic identity? Check all that apply.

First name
(Required.)

Last name (Required.)

Email
(Required.)

Which of the following topic(s) would you like to share about? Check all that apply. (Required.)

State
(Required.)

Zip Code
(Required.)

OPTIONAL. What is your race and/or ethnic identity? Check all that apply.