Rescue Application

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This form is used for Rescue Applicants

Name of Organization*
Name of person pulling animal for rescue*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Alternate Phone
Please Choose the best fit for your type of organization*
Is the organization a registered 501 (c) (3) Non-profit?*
Tax exempt ID #*
Annual animal intake #*
Annual Adoption Rate*
How many years have you been in operation?*
What animals do you accept? (Dogs, Cats, Rabbits, Equine, Small animals)
Will animals with medical issues be considered?*
Will animals with behavior issues be considered?*
Do you pull senior animals?*
Do you have any breed specific restrictions?*
What are the breed specific restrictions
Does the organization allow approved foster homes?*
Veterinarian's Name*
First Last
Veterinarian's Phone*
Clinic Name*
Email
Please list shelters or welfare organizations you work with that we may contact for a reference.*
Animal Interested In*
What is your spay/neuter policy?*
Are you able to transport multiple animals?*
How far are you able to travel to pick up animals? Miles?*
Consent
I certify by signing below that the information given is true and correct to the best of my knowledge. I hold harmless the Belmont County Animal Shelter after receipt of animals.*
I understand.
Your Name*
First Last
Your Job Title*
Signature
CAPTCHA

Consent