Welcome to HUMANE SOCIETY OF TULSA

This is an application for rescue groups to apply for donations from Humane Society of Tulsa. All applicants must be a 501c3 and listed in GuideStar (www.guidestar.org). Do not apply until you have your IRS determination letter, are established for one year from inception, and your organization's name appears in GuideStar.

Describe your organization*

Organization without a facility

Organization with a facility

Private Shelter

Municipal Shelter/Animal Control

Feral Cat Program

Pet Food Pantry

Rescue/Organization name *

Non-profit tax ID/EIN (numbers only, no hypen) *

Attach a copy of the IRS/501c3 determination letter *
Format: gif | jpg | jpeg | png | pdf Size: 2MB

Has your rescue been in existence for more than one year from the date on your IRS/501c3 determination letter? *

Yes No

Is the rescue listed in the GuideStar database (to check, visit www.guidestar.org and do a basic search) *

Yes No

Rescue address *

Street Address *

City *

State *

Postal / Zip Code *

Country *

Rescue phone number *

Rescue email *

Rescue website URL *

Rescue website link to adoptable animals (do not just list PetFinder or Adopt-A-Pet) *

Rescue Facebook page

Rescue's mission statement *

Describe adoption programs *

Animals reside in *

Foster homes Facility Both

Spay/Neuter all animals prior to adoption *

Yes

No, please explain

Number of cats adopted in the past 12 months *

Average monthly need for cat food (lbs) *

Number of dogs adopted in the past 12 months *

Average monthly need for dog food (lbs) *

Describe food storage capabilities - include maximum food storage capacity *

Has the rescue participated in a "donated" or low cost" pet food program within the past twelve (12) months? If yes, please explain. *

Please list other food sources *

Number of paid employees *

Number of active volunteers *

Does your organization have a contract to provide Animal Control Services for any city, county or municipality? If yes, please explain*

Why is your organization requesting support from Humane Society of Tulsa *

How did you hear about Humane Society of Tulsa *

Authorized Representative
Other than yourself, identify an authorized representative who may act on behalf of the rescue.

Name *

Role at the rescue *

Phone number *

Email *

Veterinarian Reference

Veterinarian's name *

Company/Office name *

Address *

City *

State *

Postal / Zip Code *

Country *

Phone number *

Applicant Info

Application completed by *

Applicant's role at the rescue *

Address *

City *

State *

Postal / Zip Code *

Country *

Phone number *

Applicant's email *

TERMS AND CONDITIONS

1. You are authorized to sign this agreement on behalf of this organization and certify that the information set forth in this application and supporting documentation is correct.

2. You have read and understood the criteria that apply to this application and certify that the organization meets each one.

3. The IRS determination letter has not been revoked, canceled or modified.

4. That food shall be protected against dampness, deterioration, and mold or from contamination by insects, birds, rodents or other animals

5. That food spoiled or otherwise contaminated shall not be served.

6. To abide by restrictions or conditions of distribution, if any, imposed by the source of Donation and communicated to Recipient by Donor.

7. That feeding pet food to ruminant animals is prohibited.

8. To not sell, transfer, trade or barter any Donation or portion thereof in exchange for money, property or services or otherwise allow the items to enter commercial channels.

9. To release both Donor and Donor’s source(s) from any liability arising from the condition of Donation and further agrees to indemnify and hold harmless Donor and its source(s) against any and all damages, losses, claims, causes of action and suits of law or in equity or any obligation whatsoever arising out of or attributed to any action of in connection with Recipients receipt, handling or distribution of Donation.

10. That Humane Society of Tulsa may list your organization as a participant in its publications, website or other informational materials but will not sell or disclose non-contact information for any commercial purpose.

11. That goods or services are provided on an "as is" and "as available" basis. Humane Society of Tulsa expressly disclaims all warranties of any kind, whether express or implied, including, but not limited to the implied warranties of merchantability or fitness for a particular use or purpose.

12. Your organization grants to Humane Society of Tulsa the following: 1) the right to include on its website a link to your organization’s website(s), 2) the right to use any image(s) that you submit to Humane Society of Tulsa or that may be recorded by Humane Society of Tulsa during or in connection with events that involve both organizations.

13. Permit monitoring, including a site visit if requested, by a Donor representative, as reasonable and necessary to verify that compliance with criteria, receipt, handling and use of Donation conform to this Agreement.

14. Applicant grants permission to Humane Society of Tulsa and its pet products donors to use information contained in this application for their internal evaluation and response procedures.

15. All Handling Fee payments are to be made payable to Humane Society of Tulsa, as requested, and in no event made to any individual or other organization.

I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS DESCRIBED IN THIS APPLICATION.*

Yes No

Submit

BRINGING PETS & PEOPLE TOGETHER KEEPING THEM TOGETHER

BRINGING PETS & PEOPLE TOGETHER KEEPING THEM TOGETHER

RESCUE APPLICATION

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