Application for Rescue Status

Contact Information

Contact information for your organization.

Name of Group or Individual  

President or Lead Person President of lead person is responsible for transfer of ownership once the animal is placed in a permanent home.

Address

City

State

Zip Code

Day Telephone

Cell

Fax

E-Mail  

Organization Information

Please provide information about your organization.

Nonprofit Status Note the organization's nonprofit status, if any,

Specific Breeds Does your organization rescue a specific breed?

Yes
No

Rescue Other Breeds Will your organization rescue other breeds?

Yes
No

Contracts, Policies, Accreditations, Associated Memberships Upload a document listing contracts, policies, accreditations, or associated memberships. File size limit: 5MB.

Veterinarian Information

Please provide contact information for your organization's veterinarian.

Name of Veterinarian

Address

City

State

Zip Code

Veterinarian's Telephone

Designated People

List up to four people from your organization who are approved to selected or pick up animals. Animals will be registered to the person who picks up the animal for the organization.

Designee 1 Name

Designee 1 Telephone Number

Designee 2 Name

Designee 2 Telephone Number

Designee 3 Name

Designee 3 Telephone Number

Designee 4 Name

Designee 4 Telephone Number