The City of San Antonio, Texas

PLEASE TYPE CITY OF SAN ANTONIO OR PRINT ANIMAL CARE SERVICES 4710 State Highway 151 San Antonio, Texas 78227 Press “Tab” Button to Office: (210) 207-6686 Fax: (210) 207-6673 Move Between Fields Email: [email protected]

GENERAL INFORMATION Organization Name: Physical Street Address: City/State: Zip: Business Mailing Address: City/State: Zip: Tel: Phone 1 Phone 2 Phone 3 Email: Website: Organization Social Media?: Facebook Twitter

ORGANIZATION INFORMATION Registered 501 c(3)? Yes No EIN: Year of IRS Incorporation: If none of the above, what type of organization are you? How long was your organization been involved in animal placement? Please list all group principles and note how long each person has been involved in animal placement:

What species of animals do you specialize in? What breeds do you specialize in?

PLEASE DESCRIBE SERVICES YOU PROVIDE? Placements in permanent homes Transfers (If Yes, See List of Attachments Section) Lifetime care Other:

CAPACITY How many animals do you plan to transfer from ACS in the next year?* How many animals do you plan to maintain in your group’s possession on average? How long (on average) does an animal stay in your group before permanent placement? How much (on average) do you plan to financially spend on each animal? *This is an estimate only. Actual number of animals transferred per year will allow for increases or decreases in the number of foster homes.

BEHAVIOR PROGRAM All animals will have a behavior evaluation prior to departing from the shelter. Please indicate who will be completing the behavior exams for your organization? Representative from your group ACS Staff Hired Professional Describe how you will ensure that each animal will receive the appropriate types and levels of exercise, environmental enrichment, human interaction, socialization, and training.

Is your organization planning on taking animals with serious behavior problems? Yes No If Yes, what serious behavior issues is your organization prepared to handle? (Also, see List of Attachments section) Serious Serious Serious Leash Excessive Fearful Behavior Housebreaking Litter Box Walking Barking Early Socialization Separation Phobias Aggression (Feral/Taming) Anxiety

MEDICAL PROGRAM Please list all veterinarian(s) and specialist(s) you work with: NAME CONTACT INFORMATION

Please describe the routine veterinary care all animals will receive when transferred to your group and describe your wellness check protocol:

Please list the medical issues your organization is prepared to handle:

Do you require all of your animals to be neutered prior to placement? Yes No If not, describe when you place intact animals:

If not, what measures do you take to ensure your animals have been neutered after placement?

FOSTER PROGRAM Page 2 of 4

How many active foster homes do you currently have?* What is the maximum number of animals that you will allow in a foster home (including

resident and foster animals)? Do you inspect your foster homes? Yes No If yes, how frequently? Do you train your fosters? Yes No If yes, describe briefly:

Please list any foster home that currently exceeds the ACS recommended guidelines of 10 animals per site. NAME ADDRESS CONTACT INFORMATION

*This is an estimate only. Actual number of animals transferred per year will allow for increases or decreases in the number of foster homes. ACS recommends including the following information in your foster database: Name, Address, Contact Information, Date of Inspection(s), Training Completed, & Current Inventory (Owned & Foster)

ADOPTION PROGRAM Please see “List of Attachments” Section for a listing of items required for this portion of the Rescue Group Application. ACS recommends including the following information in your database: Animal ID, Date Acquired from ACS, Outcome Date, Type of Outcome, Outcome Date, Outcome Name, Outcome Address, Outcome Contact Information, Behavior Notes, & Medical Notes (to include neuter status)

DESIGNATED TRASNFER MEMBERS Please list all of the volunteers or staff members and their contact information that you have designated to pick up and transfer animals for your organization. If names need to be added or deleted from this list, it is the responsibility of the rescue organization to update this list as necessary. Animals will not be released to individuals not on this list. NAME ORGANIZATION POSITION TELEPHONE NUMBER

APPLICANT NAME: DATE:

APPLICANT SIGNATURE: DATE:

**FOR OFFICE USE ONLY** Status: Approve Reject Reject Reason: Person ID: LIST OF ATTACHMENTS

ORGANIZATION INFORMATION Copy of 501c(3) Incorporation Letter Mission Statement Three (3) Letters of Reference: 1 Veterinarian, 2 Others (i.e. Adopters/Donors/Financial Backers/Humane Organizations) BEHAVIOR PROGRAM Description of your organization’s behavior plan for the serious behavior issues you are willing to handle MEDICAL PROGRAM Copy of your organization’s disease and illness prevention procedures Description of how you segregate animals by species, size, age, litters, and owned animals. Your organization’s “contingency” plan Include: plan for placement of animals in the event of: death, injury, financial disaster, dissolution of group, etc. FOSTER PROGRAM Foster Application Foster Contract Description of your organization’s foster home screening process and inspection process The following 3 attachments are” if available”: Description of your organization’s foster training program (including training about your group and on ACS procedures) Any written forms related to your foster program Foster record keeping method ADOPTION PROGRAM Description of how you promote your animals. Describe all relationships with retailers (e.g. Petsmart), when and how do adopters interact with your animals. Description of your adoption screening process. Include: a description of your screening process, policy on home visits, counseling provided to adopter, and transfer of ownership procedures. Description of your adoption follow-up program. Include: how often you follow up with adopters and how long you follow up with adopters. Do you provide any post- adoption support? Adoption Application/Agreements Fee Schedule