CAP Yearly Qualifying Form

Group Information

Group Name *

Primary Contact First Name *

Primary Contact Last Name *

Primary Contact Phone Number *

Primary Contact Alternate Phone Number

Primary Contact Email

Organization Address

Street Address 1

City

State/Province

Zip/Postal

Secondary Contact First Name

Secondary Contact Last Name

Secondary Contact Phone Number

Secondary Contact Email

Media Contact First Name

Media Contact Last Name

Media Contact Phone Number

Media Contact Email

Please supply your organizations links for the following:

Website/URL

Facebook Page

Instagram

Other Social Media Pages:

Please select which of the following best describes your group: *

Animal Control

Rescue Group

Breed Rescue

OtherOther

Are you incorporated?

Yes

No

Please upload a copy of your 501c3 paperwork.

Maximum file size: 5MB

Please list your insurance carrier.

Please upload proof of liability insurance.

Maximum file size: 5MB

Please provide us with a brief mission statement for your group.

0 of 300 max characters

Animal Information

Average number of animals available for events:

Dogs

Puppies

Cats

Kittens

Where are the animals housed? (Please check all that apply.)

Name of animal pick-up location.

(If none, please write "Meet at event site.")

Facility Address

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

Facility Phone Number

Briefly describe your intake procedures.

0 of 300 max characters

Describe how the animals are temperament tested.

0 of 300 max characters

Do you have a screening process for potential adopters?

Yes

No

Please upload a copy of your group’s adoption policies.

Maximum file size: 5MB

Will you agree to operate under the guidelines of the program that were provided for you?

Yes

No

Will you agree to use the PASS (Pet Adoption Safety Search) program during your adoption process?

Yes

No

If no, please state why.

By checking the box below and providing your digital signature, you confirm that the information you have provided is accurate, complete, and truthful to the best of your knowledge.

I agree on behalf of my organization.

Signature

Clear

CAP Yearly Qualifying Form

Please fill out the information below.

Group Information

Please supply your organizations links for the following:

Animal Information