Humane Society of Macomb Rescue Collaboration Application

Name of Organization

Are you 501c3?

Yes No

Federal ID#

Mailing Address:

City/State/Zip:

Phone Number:

EMail Address:

Main Contact/Title:

Date & State of Incorporation:

What is the purpose of your organization:

Please list your Board of Directors names and titles:

Do you carry Liability Insurance? (Not required )

Yes No

STAFF AND VOLUNTEERS

Do you have paid staff?

Yes Nu

If Yes, how many?

Do you have Volunteers?

Yes No

If so, approximately how many?

What roles do your volunteers play in your organization? (i.e. events, fostering transporting etc.)

Where are your animals housed?

How many animals do you house at a time at each location? How many animals are your foster volunteers able to foster at one time? why?

If your fosters are housing sick animals, what is the protocol? Do you allow multiple animals to go into the home? Do you require a quarantine period?

What is the typical length of stay before your animals are adopted?

What do you do if you get an outbreak of illness (parvo, ringworm,URI,etc.) in your facility or foster home?

Do you accept new kittens or pups without moms?

Yes No

VETERINARY CARE

Who is/are the Veterinarian(s) you work with?

1. Name:

Hospital Name:

Address:

Phone Number:

2. Name:

Hospital Name:

Address:

Phone Number:

ADOPTION OF ANIMALS

What type of animals to you rescue and adopt to the public?

How do people find out about your organization and adoptable animals?

Briefly describe your adoption process? What are your fees?

How many animals did you take in over the last 12 months? Comment (if appicable)

Placement number in the past 12 months?

Are your animals sterilized and vaccinated? What is your protocol? Please include age restrictions.

What is your protocol for animals upon intake?

Do you temperament test your animals/ If so, explain.

REFERENCES

Please provide three references:

1. Name/Organization:

Address:

City/State/Zip:

Phone Number:

Relationship:

2. Name/Organization:

Address:

City/State/Zip:

Phone Number:

Relationship:

3. Name/Organization:

Address:

City/State/Zip

Phone Number:

Relationship: