ACCT PHILLY LOVE LOCAL PARTNER APPLICATION

Transcription

1 ACCT PHILLY LOVE LOCAL PARTNER APPLICATION Lo e Lo al Pa t e s a e eeded to joi ith the A i al Ca e a d Co t ol Tea of Philadelphia ACCT Phill i o de to alle iate o e o di g a d to p o ide pla e e t fo a i als hose u e t edi al o eha io al o di o is ot a agea le i the shelte se g. A i als t a sfe ed to Lo e Lo al Pa t e s ill e a i ated ith age-app op iate a i a o s; addi o al edi al se i es spa / eute, i o hippi g, tes g a e a aila le depe di g o the a i als a d esou es u e tl a aila le. I o de to e app o ed as a ACCT Phill Lo e Lo al, e e se o of the appli a o ust e o pleted a d all e uested do u e ts ust e su i ed. It is solel the espo si ilit of the appli a t to e su e that appli a o s a e o pleted, as i st u ted. Application packages that do not adhered to the application standards and guidelines will not be processed for approval. Contact Information Organization Name: Maili g Add ess: Cit : State: Zip: Ph si al Add ess if diffe e t : Cit : State: Zip: Pho e: Fa : E ail: We site:

2 Authorized Representatives Autho ized Rep ese ta es efe to i di iduals ho a e autho ized to a t a d speak o ehalf of the T a sfe O ga iza o. Autho ized Rep ese ta es ill e ei e o u i a o of t a sfe eligi le a i als, a d a e autho ized to e te t a sfe ag ee e ts ith ACCT Phill a d ake de isio s o ehalf of the T a sfe O ga iza o. All Love Local Partner applicants must list at two Authorized Representatives, in addition to their organization s President/Director. Organization President or Director: Add ess: Cit : State: Zip: P i a Pho e: Se o da Pho e: E ail: Authorized Rep #1: Posi o : Pho e: E ail: Authorized Rep #2: Posi o : Pho e: E ail: REFERENCES ACCT Philly requires Love Local Partner applicants to submit the contact information of and letters of recommendations from a minimum of three references for the review process. O e efe e e ust e f o the ete i a ia ho p o ides p i a a e fo the o ga iza o s a i als. T o efe e es ust e f o shelte s o othe es ue o ga iza o s f o hi h the appli a t a ui es a i als. I addi o, e ask ou to p o ide the a e a d o ta t i fo a o of ou lo al a i al o t ol p o ide. Please p o ide o plete o ta t i fo a o fo all efe e es. Applications that do not submit applicable references and letters of recommendation will not be processed for approval.

3 Primary Veterinarian: Pho e: E ail: Add ess: Cit : State: Zip: Rela o ship ith ete i a ia a d se i es p o ided: Shelter/Rescue Reference #1: P i a Co ta t: Posi o : Pho e: E ail: Add ess: Cit : State: Zip: Rela o ship ith shelte / es ue: Shelter/Rescue Reference #2: P i a Co ta t: Posi o : Pho e: E ail: Add ess: Cit : State: Zip: Rela o ship ith shelte / es ue: Local Animal Control Provider: P i a Co ta t: Posi o : Pho e: E ail: Add ess: Cit : State: Zip:

4 OPERATING DETAILS Year Established: Annual Budget: Number of Animals Handled Annually: Average Budget, Per Animal: Does your organization have a building/facility? Is it a network of foster homes? Does it use a boarding facility, and if so, which? ACCT Philly Love Local Partners must be available for site inspection by ACCT Philly staff, if deemed necessary. Nonprofit Status. Please list EIN number or status of 501(c)3 incorporation. ACCT Philly Love Local Partners must be nonprofit organizations or private foundations with tax exempt status granted by the IRS. Documentation of nonprofit status must be in the Love Local Partner organization s name, and Partners are not permitted to act as a subsidiary to another organization. A determination letter (approved) or Form 1023 (in process) should accompany the Partner application. If the organization is a private foundation, a copy of the most recent 990-PF should accompany the Partner application. What is your organization s spay/neuter policy? ACCT Philly Love Local Partners must provide pre-adoption sterilization of all animals, including pediatric surgery for dogs and cats. All Partner must provide spay/neuter surgery for all animals, prior to adoption. Exceptions are allowed only when specifically recommended by a veterinarian for the health of an individual animal. Does your organization specialize in the care and placement of any type of animal? ACCT Philly intakes a high volume of both medical and behaviorally urgent animals on practically a daily basis. Love Local

5 Partners are needed to accommodate animals who may be suffering from injury or disease, or animals whose behavior may be concerning to continue housing in the shelter environment. What type of animals are you expecting to transfer from ACCT Philly? Bo le-feede ki e s Bo le-feede puppies Ki e s ithout othe Puppies ithout othe Ki e s ith othe Puppies ith othe Cats suffe i g f o ill ess/disease Dogs suffe i g f o ill ess/disease Cats suffe i g f o i ju /t au a Dogs suffe i g f o i ju /t au a Health a d So ial ats Health a d so ial dogs Se io ats Se io dogs S all a i als S all eed dogs Fa a i als La ge eed dogs Rep les a d E o s B eed Spe ifi s: SUPPORTING DOCUMENTS The follo i g suppo g do u e ts a e e ui ed fo su issio : Foste /Adop o Appli a o Ke el Li e se if appli a le Foste /Adop o Co t a t Spa /Neute Co t a t IRS Dete i a o Le e o Fo Sig ed Ma ual A k o ledge e t Fo Le e s of Re o e da o Shelte Le e of Re o e da o Vete i a Completed application and supporting documents should be sent using one of the following methods: ed to lifesaving@acctphilly.org Mailed to ACCT Philly, Attn: Lifesaving. 111 W. Hunting Park Ave. Philadelphia, PA 19140

6 LOVE LOCAL PARTNER AGREEMENT As pa t e i g a i al elfa e o ga iza o s, ACCT Phill Lo e Lo al Pa t e s a e e pe ted to eha e i alig e t ith ACCT Phill s o e alues of T a spa e, Respe t, I o a o, Co it e t, E path, a d P ofessio alis. Upo appli a o fo ACCT Phill s Lo e Lo al Pa t e P og a, ou o ga iza o ag ees to the follo i g: Pa t e a k o ledges that The A i al Ca e a d Co t ol Tea of Philadelphia ill p o ide all a i al i fo a o u e tl a aila le, ut akes o e p ess o i plied a a es a out the health o sou d ess of the a i als t a sfe ed a d akes o gua a tees to the eha io o disposi o of a i als t a sfe ed. Pa t e ill ope l dis lose the full, a aila le histo of t a sfe ed a i als to the pu li. Pa t e ill ai tai a ete i a ia of e o d, o a ela o ship ith a ete i a ia o ete i a p a e a d p o ide o goi g health a e fo a i als t a sfe ed hile i the Pa t e s a e. Pa t e ill fa ilitate a d autho ize the sha i g of edi al i fo a o et ee o ga iza o s ete i a ia s of e o d, a d that of ACCT Phill ete i a ia s. Pa t e ill o f Lifesa i g Ma age p io to aki g a eutha asia de isio of a t a sfe ed a i al. Pa t e ill o f Lifesa i g Ma age p io to pla i g a t a sfe ed a i al ith a othe o ga iza o. Pa t e ill o f Lifesa i g Ma age, ith hou s o e, if a t a sfe ed a i al ust e etu ed a d dis lose full histo of a i al. Pa t e ill ai tai a a u ate Autho ized Rep ese ta e list o file ith ACCT Phill of those ho a e autho ized to sele t a i als fo t a sfe a d a t o ehalf of thei o ga iza o. Pa t e ill ai tai a u ate a d app op iate adop o a d ete i a e o ds of all a i als t a sfe ed f o ACCT Phill fo a i i u of ea s. Pa t e ill p o ide ACCT Phill ith a a d all e o ds ela g to the a e, pla e e t, t eat e t, a d ste iliza o of t a sfe ed a i als upo e uest. Pa t e ill pe it the A i al Ca e a d Co t ol Tea of Philadelphia to i spe t Lo e Lo al Pa t e O ga iza o fa ili es, ith easo a le o e, du i g usi ess hou s.

7 Pa t e ill alue ea h othe s olu tee s, e plo ees, a d ep ese ta es, t ea g e e o e ith espe t a d p ofessio al ou tes. Pa t e il follo the desig ated hai of o a d to i ediatel add ess all o e s o o plai ts to the Lifesa i g Ma age athe tha ith F o tli e Staff. Pa t e ill sig edi al ai e s fo all edi all u ge t a i als, a d pu sue i ediate ete i a t eat e t to assess all a i als t a sfe ed a d to p o ide e edial a d ete i a a e, as eeded. Pa t e ill add ess a edi al o eha io al p o le s that the a i als t a sfe ed a ha e, a d e su e that a i als a e housed a d a ed fo i a e i o e t that is suita le to thei eeds. Pa t e ill p o ide a i als t a sfe ed ith ut i o all ade uate food, lea ate, a d e e ise suffi ie t to ai tai the health a d ell- ei g of the a i al. Pa t e ill e su e that all a i als a e su gi all ste ilized, p io to pla e e t fo adop o. Pa t e ill pa fo a e pe ses i u ed ela g to the ete i a a e a d asi hus a d eeds of the a i als t a sfe ed, a d ai e a ights to lai ei u se e t of said osts a d e pe ses f o the A i al Ca e a d Co t ol Tea of Philadelphia. Pa t e a su e de a i als to ACCT Phill, gi e e te ua g i u sta es. The a t of su e de i g a a i al is take as ad issio of i a ilit to p o ide ade uate a e th ough the pa t e i g o ga iza o, a d Pa t e ill ot e eligi le to t a sfe that sa e a i al, a d a e est i ted i futu e t a sfe p i iliges. Pa t e ill pi k up, o a a ge pi k up fo, t a sfe ed a i als ithi hou s of o i a a ged Lifesa i g a age e t. g, u less othe ise Pa t e ill pa ipate i a a ual e e fi a o e ie to e e Pa t e status. Pa t e ill ake a lifelo g o it e t to a i als t a sfe ed i to thei p og a s, a d ill a o odate all a i als at ACCT Phill ho e e p e iousl o ed o t a sfe ed to thei o ga iza o. Pa t e assu es all legal espo si ilit a d lia ilit asso iated ith a i als t a sfe ed, a d of a i ide ts pe tai i g to that a i al.

8 Pa t e a ot e gage i t a sfe a i es hile i ol ed i a i i al ase i ol i g uelt o egle t. Pa t e ill p o ide fo the sale of a dog li e se to a eside t of Philadelphia ho is adop g a dog. Pa t e ust t a sfe a i als fo a e a d adop o th ough thei o p og a s. Pa t e ill ot t a sfe a i als f o ACCT Phill ith the spe ifi i te t of pla i g that a i al ith a othe o ga iza o. Pa t e ill isit ACCT Phill du i g Lifesa i g hou s of ope a o, ith the sole i te t of sele g a i als to a o odate th ough the T a sfe P og a, a d ill ot loite o shelte g ou ds, oe e ACCT Phill lie tele, o e gage i a i es othe ise u elated to the t a sfe of a a i al. Pa t e ill o pl ith a fede al, state, a d lo al la s, appli a le to t a sfe ed a i als, i ludi g the e e al of appli a le ke el li e si g fo the Lo e Lo al Pa t e o ga iza o, as ell as ep ese ta es a d foste pa e ts of the o ga iza o. Pa t e does he e i de if, elease, a d fo e e dis ha ge a d hold ha less ACCT Phill a d its su esso s a d assig s f o a a d all lia ilit, lai s, a d de a ds of hate e ki d o atu e, eithe i la o i e uit, hi h a ise o a he ea e a ise f o T a sfe P og a a i es ith ACCT Phill. Pa t e ill ai e a d fo feit a a d all lai s that the Lo e Lo al Pa t e O ga iza o o ep ese ta es a ha e i the futu e agai st the A i al Ca e a d Co t ol Tea of Philadelphia. Pa t e e su es that all Autho ized Rep ese ta es ha e ead th ough the Lo e Lo al Pa t e Ma ual, a d ha e filled out a d su it a Lo e Lo al Pa t e Ma ual A k o ledge e t fo to the Lifesa i g Ma age. Pa t e s ho ish to e gage i ACCT Phill olu tee a i es ust do so th ough the app op iate olu tee i g p o ess.. G oup e e ts a e s heduled th ough the ACCT Phill Volu tee Coo di ato. Signature Title Date THANK YOU! Tha k ou fo ou i te est i helpi g ACCT Phill sa e the li es of Philadelphia s ho eless, o pha ed, a d a a do ed a i als! Appli a o pa kages a take a he e f o o e da to se e al eeks to p o ess, depe di g o ho ui kl efe e es a e ea hed. You ill e o ta ted sho tl a ACCT Phill staff a out the status of ou appli a o.