Rescue Application Form

Application for Rescues to The Anti-Cruelty Society
Status

New SubmissionUpdated Submission: Our info has changed, expired or lapsed since approval. We are submitting this so you can update your file.
Today's Date*

MonthDayYear
INFORMATION ABOUT YOUR RESCUE
We rescue*

DogsCatsRabbitsOther small mammalsReptilesEquineWildlifeBirds
We are a (check all that apply)

Foster-based rescue using only foster homesFoster-based rescue which also uses boardingFoster-based rescue which also houses cats in a pet store environmentNo-kill shelter with controls on intakeOpen-intake public or county shelter that may euthanize for space or temperamentSanctuary that does adoptionsSanctuary that does not do adoptionsOther
If you are breed-specific, please indicate breed(s) here
Rescue Name:*
Your Name*
Your Title*
Your Website*
Facebook
What other sites do you have? (Check all that apply)*

PetfinderAdoptAPetRescueGroupsRescueMeFacebookTwitterInstagramOther
Mailing Address For Your Rescue (This will appear on the health certificate.)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County in which your rescue is headquartered*
Your Email Address*
Your Cell Phone Number*

Area CodePhone Number
Your Rescue's Phone Number (if applicable)

Area CodePhone Number
We request authorized puller information to prevent third-party individuals from falsely pulling animals under your rescue's name. Should your authorized puller contacts change, please notify us by submitting this form again and we will update our files.
Authorized Pullers*

I am the only person authorized to pull animals for this rescueWe have more than one authorized puller. I will list their info below.Other
Authorized Puller 2

First NameLast Name
Authorized Puller 2 Title
Authorized Puller 2 Email
Authorized Puller 2 Cell Phone

Area CodePhone Number
Authorized Puller 3

First NameLast Name
Authorized Puller 3 Title
Authorized Puller 3 Email
example@example.com
Authorized Puller 3 Cell Phone

Area CodePhone Number
Is your rescue a 501(c)(3) non-profit?*

YesNoApplication in progressOther
If your rescue does not have a federal EIN # and it's registered under an individual's social security number instead, please do not list that SS # in the EIN box below. Instead, just put this: SS#/private. We are not interested in receiving anyone's social security number. Please keep that information private.
What is your EIN?*
Does your organization breed?*

YesNoOther
What is your Department of Agriculture license number and what state is it for?*
How long has your rescue been in operation?*
How many animals do you place in homes annually?*
How many foster homes do you have?*
If you board, what facility do you use?
REFERENCES: Please provide your veterinarian's contact information.
Veterinarian Name*

First NameLast Name
E-mail*
Cell*

Area CodePhone Number
YOUR RESCUE'S PROCESSES AND POLICIES
Do you require animals to be spayed or neutered before adoption? *

YesNoOther
What type of accommodations does your rescue provide for the rescue animals? Check all that apply.*

Foster homeKennel on our propertyGarageLives outdoors in fenced yard or dog runNo-Kill shelter with physical buildingBoarded at vetLicensed kennel facility not on our propertyCats are kept at Petco or Petsmart in cagesCats are boarded at our vetCats are free roaming in fosterOther
Do you agree NOT to have unnecessary, cosmetic surgery performed such as ear cropping, tail docking, & declawing?*

YesNoOther
Do you agree to keep fosters current on vaccinations while in your care & to find a home that will agree?*

YesNoOther
Do you understand that if any of the information on this application is found to be false, or if we find the animal you are rescuing from us is not being given the proper care (personal or veterinarian), we will reclaim the animal?*

YesNoOther
TRANSPORT INFORMATION
Are you typically able to pick up animals directly from the shelter or do you require transport assistance?*
Please submit photos of your housing facilities.

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Application for Rescues to The Anti-Cruelty Society