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Wilco Regional Animal Shelter Rescue Group App
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Organization Name:
Email Address:
Organization Address, Street, City, State, Zip :
Telephone:
Your Name:
Your Phone Number:
Drivers License or ID. Number and State:
Your address, Street, City, State and Zip:
Veterinarian Name:
What is your Vets phone number:
What is your Vets address? Street, City, State and Zip:
What types of animals are you interested in rescuing?:
Cat
Dog
Other
If you selected other please list what.:
Is your Organization a 501 (c) 3, non-profit organization?:
Yes
No
If yes, attach appropriate paperwork documentation of such.:
Do you have policies in place regarding spay/neuter and vaccination of the animals who come into your care?:
Yes
No
If yes, attach appropriate documentation of such:
Is your Organization breed specific?:
Yes
No
If so, what breed?:
Do you accept mix breed animals or purebred animals only?:
Do you screen adoption applications?:
Yes
No
If yes, attach appropriate documentation of such:
Are your animals kept indoors or outdoors?:
APPROVED PERSONS REPRESENTING YOUR ORGANIZATION OR YOU
(If they are not on the list then they will not be allowed to rescue and will have to go through the regular adoption process and pay appropriate fees)
First Person:
Contact Number:
Driver's License or I.D.#:
Email:
Second Person:
Contact Number:
Driver's License or I.D.#:
Email:
Third Person:
Contact Number:
Driver's License or I.D.#:
Email:
Fourth Person:
Contact Number:
Driver's License or I.D.#:
Email:
Fifth Person:
Contact Number:
Driver's License or I.D.#:
Email:
Sixth Person:
Contact Number:
Driver's License or I.D.#:
Email:
Signature:
By signing in the box below you are agreeing to the terms of
this agreement.
Submit