RESCUE AND SHELTER APPLICATION
This is an application for rescues and shelters to apply for donations from Rescue Pack. All applicants must be a 501c3 and listed in GuideStar (www.guidestar.org). Do not apply until you have your IRS determination letter, are established for one year from the date on your IRS letter, and your organization's name appears in GuideStar. Rescue Pack only accepts applications from Illinois, Indiana, SW Michigan and Wisconsin.
Rescue/Shelter name
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Non-profit tax ID/EIN (numbers only, no hypen)
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Attach a copy of the IRS/501c3 determination letter
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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.
Yes
No
Are you an approved rescue/shelter by the Deptartment of Agriculture in your state?
Yes
No
Not Required My State
Is your organization listed in the GuideStar database (to check, visit www.guidestar.org and do a basic search)
Yes
No
Rescue/Shelter address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Rescue/Shelter phone number
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Area Code
Phone Number
Rescue/Shelter email
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Rescue/Shelter website URL
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Weblink to adoptable animals
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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
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Describe adoption programs
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Animals reside in
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Foster homes
Facility
Both
Spay/Neuter all animals prior to adoption
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Yes
No, please explain
Explanation Area:
Number of cats adopted in the past 12 months
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Number of cats in current population
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Average monthly need for cat food (lbs)
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Number of dogs adopted in the past 12 months
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Number of dogs in current population
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Average monthly need for dog food (lbs)
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Describe food storage capabilities - include maximum food storage capacity
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Please identify how you currently acquire food
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Number of paid employees
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Number of active volunteers
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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
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How did you hear about Rescue Pack
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Board Members
President's Name
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First Name
Last Name
President's Email
*
Vice President's Name
*
First Name
Last Name
Vice President's Email
*
Secretary's Name
*
First Name
Last Name
Secretary's Email
*
Treasurer's Name
First Name
Last Name
Treasurer's Email
Authorized Representative
Other than yourself, identify an authorized representative who may act on behalf of the rescue.
Authorized Representative Name
*
First Name
Last Name
Role at the rescue
*
Phone number
*
-
Area Code
Phone Number
Email
*
Veterinarian Reference
Veterinarian's name
*
First Name
Last Name
Company/Office name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone number
*
-
Area Code
Phone Number
Applicant Info
Application completed by
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First Name
Last Name
Applicant's role at the Rescue/Shelter
*
Applicant's mobile phone number
*
-
Area Code
Phone 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.
Yes
No
Signature
*
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