Rescue Partner Signup
Organization Information
Name of Organization
*
How long has your organization existed?
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the address listed above a physical location address or mailing address?
*
Physical Location Address
Mailing address Only
If you have a secondary address, please list it here:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What type of address is your secondary address?
Physical Location Address
Mailing address Only
Primary Contact
*
First Name
Last Name
Title
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred method of contact:
Phone
Text
Email
Facebook Messenger
Other
Please list all the first and last name and phone number(s) of all personnel authorized to pull animals under your organization's license.
*
Is this organization currently listed with the State?
*
Yes
No
Not Required
Does this organization hold a current 501(c)(3) status?
*
Yes
No
Does the organization use PetPoint?
Yes
No
What types of animals does your organization accept?
*
Dogs
Cats
Birds
Small Mammals
Reptiles
Other
What specific breeds do you look for, if any?
Please list the types of pets that you would consider taking into your program (select all that apply)
Dog with a bite history
Behavioral concerns
Pregnant dogs
Nursing dogs
Heartworm positive dogs
Underage puppies without a mother
Breed-specific pets
Medical pets
Other
Would you accept heartworm positive dogs?
Yes
No
Maybe
Under what circumstances would you euthanize an animal in your program? Please explain.
*
Are you willing/able to assist with transport needs the dog may have in getting from KC Pet Project to your program?
Yes
No
Maybe, depends on the situation
How many animals does your organization take in annually?
*
How does your organization house the animals currently in your program?
*
Foster Home
Shelter
Boarding
Other
References
Reference #1 Name
*
Relationship
*
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Reference #2 Name
Relationship
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Reference #3 Name
Relationship
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
End
Local Animal Control Agency Name
Local Animal Control Agency Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Veterinarian Name
Veterinarian Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Department of Agriculture License
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501(3)(c)
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By signing below ,I/we agree to allow Kansas City Pet Project the right of first refusal to ownership of the above-described animal if at any time we are unable or unwilling to care for the animal and are considering euthanasia for it. I/we agree to contact Kansas City Pet Project and, if so desired by Kansas City Pet Project, return said animal to Kansas City Pet Project for evaluation so that Kansas City Pet Project may make an informed decision prior to exercising their right of first refusal. Rescue representative understands that animals are unpredictable, and the City of Kansas City and Kansas City Pet Project cannot guarantee appropriate behavior of animals transferred from our facility. Rescue representative acknowledges the City and Kansas City Pet Project has not made through its agents, volunteers or employees, any guarantees regarding the future condition, temperament or conduct of the animal, including bites, and Rescue Representative hereby fully and completely release, indemnify, and hold harmless the City and Kansas City Pet Project, its officers, directors, volunteers, agents, servants and employees from any claim, cause of action or liability of any sore or nature, whether known or unknown, directly arising out of, or, in connection with the adoption, care, or ownership, maintenance, retention, temperament, conduct or condition of the animal.
*
I agree
Signature
*
Date
*
-
Month
-
Day
Year
Date
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