HWAH- Rescue Partner Qualification Form
Name of Rescue
Name of Contact person
Address (Please note that the address listed below MUST match the address listed on the submitted invoice, Guidestar, or organization website.)
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