Rescue Waggin’ Source/Destination Shelter Application
We are applying to be a Source Shelter Destination Shelter
Application Date:Click here to enter a date.
Organization Name: Click here to enter text.
Address:Click here to enter text.
City: Click here to enter text. State: ZIP Code:
Mailing Address (if different than above): Click here to enter text.
City: Click here to enter text. State: Zip Code:
Organization Website: Click here to enter text.
Primary Contact Person: Title: Click here to enter text.
Email Address: Telephone: Click here to enter text.
Shelter Director and Title (if different from above): Click here to enter text.
Telephone: Email:
Do you have a physical building? Select One.
If so, square footage: Click here to enter text.
Agency Type:Choose an item.
Annual operating budget: Click here to enter text.
Are you an open admission or limited admission facility? select
How do you accept animals from the public? Choose an item.
How much is your admitting fee per animal? Click here to enter text. We don’t charge
Number of full-time employees :# Number of part-time employees: #
Number of Volunteers active at least once per month for 2 hours:Click here to enter text.
Please complete the following table regarding canine intake and outcome data:
Canine Intake and Outcome Data2013 / 2014 to date
Dogs and puppies taken into care
Dogs and puppies adopted
Dogs and puppies returned to owners
Dogs and puppies transferred to other organizations
Dogs and puppies euthanized
Shelter Mgmt Software: Choose an item.
Tell us about your current transport efforts and rescue partnerships:
Click here to enter text.
Method of euthanasia: Choose an item.
If other, please elaborate: Click here to enter text.
Where are your animals housed? Choose an item.
How many of the following do you have?
Foster Homes / Concrete Dog Runs / Metal/Other cagingWhere do you perform adoptions? Shelter Foster Home Mobile Sites Other
If other, please elaborate: Click here to enter text.
Describe your adoption and screening process:
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How much is your adoption fee for dogs? Click here to enter text.
Please check all that is included in the adoption fee:
Exam Rabies Vaccine Combination Distemper Intranasal Bordatella
Microchip Flea Preventative, type: Click here to enter text. Spay or neuter
Heartworm Test, type Click here to enter text. Collar and tag(s) Other: Click here to enter text.
How do you assess canine behavior? We do not currently do assessments SAFER Assess-A- Pet Other:Click here to enter text.
Do you have a veterinarian on site? Yes No a local veterinarian routinely visits
How often is the veterinarian at your facility? Click here to enter text.
Do you transport animals to the veterinarian? Yes No
If yes, how often?Click here to enter text.
How long does it take you to travel to your veterinarian? Click here to enter text.
Veterinarian’s Name: Click here to enter text. Veterinarian’s Telephone:
Describe your intake and vaccination procedures for dogs:
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Describe your intake and vaccination procedures for puppies:
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How do you ensure animals are spayed or neutered?
We don’t have a system for ensuring it is done.
We S/N prior to releasing the animal to adopters.
Collect a deposit from adopters and refund it after they have had the pet altered.
Other: Click here to enter text.
Add any additional comments here:
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Thank you for your interest in the PetSmart Charities Rescue Waggin’ program.
Due to the large volume of applications received it can take 4-6 weeks to hear back from us.
Please email your completed application to