RESCUE AND SHELTER REAPPLICATION

Rescue/Shelter name*

Non-profit tax ID/EIN (numbers only, no hypen)*

Attach a copy of the IRS/501c3 determination letter*

Has your organization been in existence for more than one year from the date on your IRS/501c3 determination letter? IF YOUR ANSWER IS NO, DO NOT COMPLETE THIS APPLICATION. We won’t review or approve your application until it has been one full year.

YesNo

Are you an approved rescue/shelter by the Deptartment of Agriculture in your state?

YesNoNot Required My State

Is your organization listed in the GuideStar database (to check, visit www.guidestar.org and do a basic search)

YesNo

Rescue/Shelter address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Rescue/Shelter phone number*

Area CodePhone Number

Rescue/Shelter email*

Rescue/Shelter website URL*

Weblink to adoptable animals*

Please provide your organization's distinct weblink for your adoptable animals. Simply writing "Petfinder" or "Adoptapet" is not sufficient; we need the specific URL that links directly to your organization's adoptable pets.

Social Media Page (i.e. Facebook or Instagram)

Rescue/Shelter mission statement*

Describe adoption programs*

Animals reside in*

Foster homesFacilityBoth

Spay/Neuter all animals prior to adoption*

YesNo, please explain

Explanation Area:

Number of cats adopted in the past 12 months*

Number of cats in current population*

Average monthly need for cat food (lbs)*

Number of dogs adopted in the past 12 months*

Number of dogs in current population*

Average monthly need for dog food (lbs)*

Describe food storage capabilities - include maximum food storage capacity*

Please identify how you currently acquire food*

Number of paid employees*

Number of active volunteers*

Does your organization have a contract to provide Animal Control Services for any city, county or municipality? If yes, please explain*

Why is your organization requesting support from Rescue Pack*

How did you hear about Rescue Pack*

President's Name*

First NameLast Name

President's Email*

Vice President's Name*

First NameLast Name

Vice President's Email*

Secretary's Name*

First NameLast Name

Secretary's Email*

Treasurer's Name

First NameLast Name

Treasurer's Email

Authorized Representative Name*

First NameLast Name

Role at the rescue*

Phone number*

Area CodePhone Number

Email*

Veterinarian's name*

First NameLast Name

Company/Office name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone number*

Area CodePhone Number

Application completed by*

First NameLast Name

Applicant's role at the Rescue/Shelter*

Applicant's mobile phone number*

Area CodePhone Number

Applicant's email*

TERMS AND CONDITIONS

You are authorized to sign this agreement on behalf of this organization and certify that the information set forth in this application and supporting documentation is correct.
You have read and understood the criteria that apply to this application and certify that the organization meets each one.
The IRS determination letter has not been revoked, canceled or modified.
That food shall be protected against dampness, deterioration, and mold or from contamination by insects, birds, rodents or other animals
That food spoiled or otherwise contaminated shall not be served.
To abide by restrictions or conditions of distribution, if any, imposed by the source of Donation and communicated to Recipient by Donor.
That feeding pet food to ruminant animals is prohibited.
To not sell, transfer, trade or barter any Donation or portion thereof in exchange for money, property or services or otherwise allow the items to enter commercial channels.
To release both Donor and Donor’s source(s) from any liability arising from the condition of Donation and further agrees to indemnify and hold harmless Donor and its source(s) against any and all damages, losses, claims, causes of action and suits of law or in equity or any obligation whatsoever arising out of or attributed to any action of in connection with Recipients receipt, handling or distribution of Donation.
That Rescue Pack may list your organization as a participant in its publications, website or other informational materials but will not sell or disclose non-contact information for any commercial purpose.
That goods or services are provided on an "as is" and "as available" basis. Rescue Pack expressly disclaims all warranties of any kind, whether express or implied, including, but not limited to the implied warranties of merchantability or fitness for a particular use or purpose.
Your organization grants to Rescue Pack the following: 1) the right to include on its website a link to your organization’s website(s), 2) the right to use any image(s) that you submit to Rescue Pack or that may be recorded by Rescue Pack during or in connection with events that involve both organizations.
Permit monitoring, including a site visit if requested, by a Donor representative, as reasonable and necessary to verify that compliance with criteria, receipt, handling and use of Donation conform to this Agreement.
Applicant grants permission to Rescue Pack and its pet products donors to use information contained in this application for their internal evaluation and response procedures.
All Handling Fee payments are to be made payable to Rescue Pack, as requested, and in no event made to any individual or other organization.

I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS DESCRIBED IN THIS APPLICATION.

YesNo

Signature*

RESCUE AND SHELTER APPLICATION

Board Members

Authorized Representative

Veterinarian Reference

Applicant Info