Oregon Humane Society Pet Rescue Group Application

Oregon Humane Society Rescue Group Application

* Required fields

1. Date:

(mm/dd/yy)

2. Name

* (Your name not group name)

3. Address

4. City

5. State

6. Zip

7. Home phone:

8. Work phone:

8 (a) Email

List up to two volunteers (if applicable) who can be contacted by the public
in addition to yourself

9. Volunteer #1

10. City

11. State

12. Phone:

13.Volunteer #2

14. City

15. State

16. Phone

17. Name of breed/animal *

18. Name of rescue group (if any) *

(If you don't have a rescue group name, please write "none" in the box)

Please answer yes or no to the following.
Use the text box at the end of the form to elaborate if necessary.

19. Do you breed? Yes No *

If yes, how many litters have you had in the last five years? *

20. How many animals have you placed in new homes? *

21. Do you require an adoption application? Yes No *

22. Do you require an adoption contract? Yes No *

23. Do you provide foster care while awaiting adoption? Yes No *

If yes, what kind of confinement do you require/provide? *

24. If you do not provide foster care do you only do referrals? Yes No *

25. Do you require animals to be spayed or neutered before adoption? Yes No *

If no, do you require spaying/neutering after adoption? Yes No *

26. Do you do site visits to check potential adoption situations? Yes No *

If yes, do you conduct site visits for each adoption? Yes No *

If you don't conduct site visits each time, then how often do you do visits? *

27. Are you willing to be a resource for people with questions about the breed/animal?
Yes No *

28. How many years have you been involved with rescue? *

29. Please provide two references who can tell us about your rescue work and your group's reputation (one MUST be a vet). Two references are required to be approved by OHS.. In addition, please provide the name and number of the closest animal shelter to you along with a contact name (required).

30. Reference name: *

31. Relationship: *

32. Phone number(s): *

33. Reference name: *

34. Relationship: *

35. Phone number(s): *

Nearest animal shelter:

Shelter name: *

Shelter phone number: *

Contact name: *

The following questions relate to the rescue web site. Please check all the information that you want included on the web page.

36. Do you want to be listed on the Oregon Humane Society rescue group web page on the Internet? *

Yes No

Rescue group name: My name: Address: Home phone:
Work phone: Email

Another volunteer's name, phone, email If so, please give name and information below

38. Do you have a web site? Yes No

If so, please enter the URL here:

39. Please give us any information you feel is necessary for us to better
understand your answers or additional information you wish us to know.

Have you filled in all the required fields - including reference information?

Contact site webmaster