Animal Rescue Insurance Application

Hidden

Status

Business Name

Name(Required)

First Last

Title

Mailing Address

Address

Street Address Address Line 2 City State ZIP Code

Location Address

Address

Street Address Address Line 2 City State ZIP Code

County

Business Contact Information

Business Phone

Home Phone

Fax Number

Website Address

Email(Required)

Enter Email Confirm Email

Buisness Information

Type of Ownership:

Corporation

Non Profit

Other

How many years have you been in business?

Federal ID Number

Present Insurance Carrier

Exp. Date of Insurance

Have you had any claims in the past 5 years?

Annual Revenues

501 © 3 Status

Location Information - Where Administrative Work is Done

Age of Building

Sq. Feet of Office Space

Distance to Fire Hydrant

Distance to Fire Dept.

Construction of Building

Frame

Brick

Volunteer Information

Do you have Volunteers?

If Yes, # of Volunteers

What kind of training do you provide for your volunteers?

Length of training period for volunteers

Do you have all volunteers sign a Hold Harmless Waiver?

Is there a Volunteer Procedure Manual in place?

Do you require any background experience in the animal care field for volunteers?

What is the age limitation for volunteers?

Do you require a Parent or Guardian to sign for volunteers under the age of 18?

Do you require a Parent or Guardian to be present with under age volunteer when doing volunteer duties?

Do you do obedience training?

Are animals trained, owned by you?

Do you offer training to the public?

If Yes, do you have a Liability Waiver signed?

Do you offer a Spay/Neuter Program to the public?

Do you have certified therapy dogs?

If Yes, how many?

Do you have adoption forms with Hold Harmless Waiver?

Do you have any people you pay Perdiem?

1099's

Do you have any people you sub-contract?

Do you use pet stores as a source for adoptions?

If so, please complete the Supplemental Pet Store Application portion of the form below.

Do you operate in more than one state?

If so, how many?

How many events do you participate in?

Provide a list of events:

Evaluation Procedures on Rescued Animals

How are animals evaluated?

How are animals handled if they show aggression?

Are animals still placed if there is aggression towards People?

Other Animals?

Food?

What procedures are taken if the animal has bitten someone?

Who makes the decision if the animal has to be euthanized?

If you have an animal that is a known biter, do you place it up for adoption?

Where do you get your animals from who are taken into your rescue?

Rescues

Shelters

Private Pet Owners

Puppy Mills

Dog Clubs

Trainers

Kennels

Foster Care Information

# Foster Care Homes:

How are they evaluated?

Is there an application that foster homes must complete?

Do you have them sign a Hold Harmless Waiver?

Is you foster care applicant a volunteer?

What kind of training is provided for foster homes?

Do you place a dog/cat into foster care before you evaluate for temperament or aggression?

Do you place your rescue dogs/cats into a foster home who have children?

If so, what is the age of children?

How much past experience in the animal care field do you require your foster home to have?

When a foster goes on vacation, what happens to the foster dog or cat?

Do you allow your foster home to keep an animal that is unadoptable to the public?

Application can only be completed and signed by President, Chairman or Executive Director. When your application is sent we will need 3 Year Loss History from your present insurance carrier or if no prior insurance then resumes must be emailed to us. Resumes must show background experience in the animal care field and what they do for a living. All applications must be fully completed and will need to be resubmitted if not completed. This will delay in in you getting a quote in a timely manner. Before coverage is bound we will need copies of Adoption Contract, Hold Harmless Forms, your Foster Care Application and any Procedure Manuals in place.

Supplemental Application for Organizations Who Use Pet Stores For Off Site Adoptions

Complete the form below if you use Pet Stores as a source for Adoptions.

Store Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Construction of Building:

Masonary

Frame

Age of Building

Distance to Fire Dept:

Distance to Fire Hydrant

Do you house animals at the store on a full-time basis?

If Yes, # of Cats:

# of Dogs

Who maintains the care of the animals?

Do you take animals to the pet store for one day adoptions?

If Yes, # of Cats:

# of Dogs

# of Volunteers or Employees who oversee the adoption day:

How often do you do the one day adoptions?

What supervision is provided at the adoptions?

Do you have written procedures in place for volunteers or employees who oversee the adoption?

What kind of training & education do you provide for your volunteers or employees in regards to "A Safe Adoption Event"?

Are signs posted on cages "Warning to Keep Hands/Fingers Out"?

Are dogs leashed when outside of cages/crates?

Is there a designated area roped off to keep the public from interacting with the animals?