HWAH- Rescue Partner Qualification Form
Name of Rescue
Name of Contact person
StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDisctrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisonsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
Date of 501(c)(3)
Do you do Home Visits before Placement?
Will you take a dog/cat back if the adopter wants to give it up?
You agree to give regular updates and pictures for the dogs/cats that we help.
Please attach a copy of your adoption contract:
Rescue Vet Reference
Rescue Vet's Phone number
Rescue Groomer Reference
Rescue Groomer's Phone number
Please list 2 References below:
1st Adopter Reference Name
Adopted Dog/Cat Info
1st Adopter Reference phone #
2nd Adopter Reference Name
2nd Adopter Reference phone #
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: HWAH- Rescue Partner Qualification Form
Agree & Sign