Rescue Partner Information Update

What is the structure of your organization?*

Non-profit, 501C3Municipal OrganizationOther

What is your EIN number?*

What was your operating budget last calendar year?*

How many adoptions did your organization do last calendar year?*

What types of animals do you specialize in rescuing (check all that apply*

Does your organization specialize in a certain breed of pet?*

YesNo

Please list them below.

Does your organization specialize in a certain age range of pets (example: seniors, bottle babies, etc...)?*

YesNo

Please list them below.

Do you only accept pets in that category?

YesNo

12. Please check the following medical conditions in which your organization CAN accept (check all that apply)*

Please list any medical conditions your organization CANNOT accept:*

Please list behavior conditions your organization CANNOT accept:*

What is the name of your regular veterinarian*

What is your veterinarian's practice or business name?*

Veterinarian's Phone Number*

Please enter a valid phone number.

Veterinarian's Email*

example@example.com

Veterinarian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long have you used this veterinarian?*

What type of behavioral training methods does your organization use?*

If your organization uses a specific trainer, please provide their contact information (name, email, phone, website):*

If an animal shows dangerous or concerning behavior and does not respond to behavior modification, what is your next step?*

How many animals are currently in your care?*

What is the maximum amount of animals you are able to care for at a time?*

How do you house the animals in your care?*

Do you have a designated shelter facility?*

YesNo

Name of facility

Address of facility

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How many animals are housed at this facility location?

Do you utilize foster care providers to house animals?*

YesNo

Please describe how you screen your foster care providers:

If an animal is placed in a foster home with personal pets, will the pets be kept together or separated? Please explain:

How many animals are assigned to each foster at one time?

Are all your cats, dogs, rabbits, and pot-bellied pigs spayed or neutered prior to being adopted out?*

YesNo

Would you like to opt into receiving emails for pets in AHS care seeking rescue placement?*

YesNo

Would you like to opt into receiving emails for adoptable pets in our care that fit the description of what your organization rescues?*

YesNo

Are you a member of The Phoenix Animal Care Coalition (PAC 911)?*

YesNo

Would you like opt into receiving our daily Partner Alert email that will feature pets not on the Rescue Portal?*

YesNo

Representative's Signature

By typing my name below, I certify that I am an officer of this organization and the information I have provided is correct. I promise that I have reviewed the Arizona Humane Society’s Rescue Partner Code of Conduct and agree to be bound to the conditions presented in these guidelines.

Name*

First NameLast Name

Signature*

Rescue Partner Information Update

Questionnaire