pear_program

 

 


RESPONSIBLE PET OWNERS ALLIANCE
RESCUER APPLICATION


INDIVIDUAL:  __________________________________________________
GROUP: _____________________________________________________
ADDRESS: ___________________________________________________
CITY/STATE/ZIP:  _______________________________________________
PHONE: (_____)_______________________________________________
E-MAIL:  ______________________________________________________
WEB SITE:  ___________________________________________________
How long in rescue?: _______________

What Breed(s) or Species are you interested in rescuing?   ______________________________________________________________

What experience do you have with this breed/species?   ______________________________________________________________
______________________________________________________________
______________________________________________________________

Have you worked with any shelters previously?  ___Yes ___No 
If “Yes”, please list and attach Shelter Referral(s). 
______________________________________________________________
______________________________________________________________
______________________________________________________________

What are your adoption procedures at the present time?
______________________________________________________________
______________________________________________________________
______________________________________________________________

Please describe arrangements for housing and caring for rescued animals: ______________________________________________________________
______________________________________________________________
______________________________________________________________


Do you take back adopted animals?  ___ Yes __ No  Explain: ______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

I agree to a home visit (by appointment only) from a representative of RPOA. I agree to indemnify and hold harmless Responsible Pet Owners Alliance, Inc. and the individual rescue agent and/or group from any claims arising while participating in this program.

__________________________________
Signature

__________________________________
Date


Required Attachments: 
Code of Ethics (signed and dated), Veterinarian Referral,
Shelter Referral (if applicable)

Return to: RPOA, 900 NE Loop 410 #311-D, San Antonio, TX 78209.
Fax: (210) 822-9038




 

 

 

 

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