Rescue Partner Application

Questionnaire

Now to get to know a little more about your organization and the type of pets you work with.
What is the structure of your organization?*

Non-profit, 501C3Municipal OrganizationOther
What is your EIN number?*
How long has your organization been in existence?*
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*

CaninesFelinesSmall pocket exotic pets (rabbits, guinea pigs, rats, mice, hamsters, etc.)Domesticated birdsDomesticated reptilesFarm animals and livestock (pigs, sheep, goats, etc.)WildlifeOther
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)*

RingwormSarcoptic MangeBottle BabiesKennel Cough (Canines)URI (Felines)None
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 is the name of the veterinary you use in case of an emergency?*
What is this veterinarian's practice or business name?*
Veterinarian's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian's phone number*
Please enter a valid phone number.
Veterinarian's email*
example@example.com
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 number of animals you can care for at a time?*
Please describe how 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
Do you provide assistance with medical or behavioral problems after adoption?

YesNo
Please explain
Do you allow animal returns or exhanges?

YesNo
Please explain
Will you consent to site checks performed by the Arizona Humane Society of your facility and/or your foster homes?*

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
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
What are you hoping to achieve by entering a partnership with AHS?
References

Please list a reference for each of the following categories. In order to expedite the application process, please ensure the best contact numbers are provided and your references are aware AHS will reach out as part of the approval process.
Municipal Shelter Partner you currently have a rescue partnership with:
Shelter name*
Contact name*
Shelter address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shelter contact phone number*
Please enter a valid phone number.
Shelter contact email*
example@example.com
Non-profit animal rescue you currently work closely with
Non-profit name*
Contact name*
Non-profit address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Non-profit contact phone number*
Please enter a valid phone number.
Non-profit contact email
example@example.com
Veterinarian (if different from your primary and emergency vet)
Veterinarian name*
Veterinarian address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian phone number*
Please enter a valid phone number.
Veterinarian email
example@example.com
What do you hope to gain by partnering with the Arizona Humane Society?*
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*

Clear
Should be Empty:

Rescue Partner Application

Questionnaire

References