Specifc breeds you are interested in helping:

Contact Person:

Email:

Name of rescue:

Address:

City:      State:    Zip Code:

Your home phone number (with area code):

Alternate phone number (with area code):

Website:

Employer:

Employer phone (with area code):

SHELTER REFERENCES

Please provide references of at least two other shelters you have worked with in the past. Include shelter name, contact person, email and phone:

PERSONAL REFERENCES

Please provide at least two personal references from other rescue groups. Include name of rescue group, contact person, email and phone:

How long have you been participating in animal rescue?:

Does your rescue have 501(c)3 status:
Yes
No

Where are the animals you rescue kept until they are adopted? Please be specific. (Ex: inside your home, foster home, kennel, garage, fenced yard, no kill shelter, boarded at vet):

How many rescue animals are currently in your household?:
Dogs:
Cats:

Are all rescued animals spayed or neutered before going to their adoptive homes?
Yes
No

If the answer to the above was "no" please email a copy of your spay/neuter contract to mercerhumane@hotmail.com

Name of your current veterninarian:

Veterinarian phone:

If you have switched veterinarians in the last two years please list your previous veterinarian.

Previous veterinarian name:

Previous veterinarian phone:

Do you agree NOT to have unnecessary surgery performed such as; ears cropped, tail dock, all 4 declawing on cats?:
Yes
No

Do you agree to keep this pet on monthly flea & tick control while in your care and to find a home that will agree to the same?:
Yes
No

If for ANY reason the adoptive home doesn't want to keep the pet they adopted from your rescue is it mandatory that the pet be returned to you?:
Yes
No

Do you agree not to euthanize any animal that our shelter has sent you unless checking with us first?:
Yes
No

ABOUT WHERE YOU LIVE

Type of dwelling:
I live in an apartment.
I live in a condominium.
I live in a single family home.
I live on a farm.
I live in a mobile home.
Other. Please describe:

Location:
City
County
Suburb

Describe your city/county zoning laws pertaining to domestic animals:

ABOUT THIS APPLICATION

May we do a follow up call or visit after you have rescued?:
Yes
No

Do you understand that it is mandatory that the animal you are rescuing from us be spayed/neutered before going to your rescue? (There are exceptinos with puppies and kittens due to age and size):
Yes
No

Do you understand that if any information on this application is found to be false, or if we find the animal you are rescuing from us is not being given the proper care (personal or medical) we will reclaim the animal at no expense to us?:
Yes
No

After you have offered rescue, if the dog/puppy gets adopted through our shelter before transport to a "good" home, is that ok?:
Yes
No

PAYMENT POLICY

You will be invoiced via email for charges incurred for the pet you are rescuing. Payments can be made via mail or paypal. Costs are as follows:

Spay or Neuter – dependent upon size and sex of pet but is around $50 to $60
Health certificate - $15
DHPP/Nemex - $10
Rabies (4+ months of age)- $5 to $8
HW test (only performed on dogs 6+ months of age unless requested) - $15 to $20
Feline Leukemia & AIDS testing for cats - $15
Microchip (upon request) - $15
* Drontal plus is available but varies on weight for each dog/cat. Please contact us for a quote if this is desired. Other veterinary services are available upon request.

By clicking on “Submit Application” I am agreeing that the above information is true and correct and by applying to rescue I hereby give permission to my Veterinarian and my personal references to disclose information to Mercer Humane Society.