HSSI Rescue Application

Organization and Contact Information Thank you for choosing to partner with us! As the ONLY Open Access facility in Southern Illinois that will accept ANYTHING that comes through our door, we need Rescue partners like YOU, to continue to save as many lives as possible. Once this form has been filled out, the organization's 501(c) 3 and Department of Ag license is on file, we will officially be partners! We cannot wait to start working with you!
Today's Date *
Organization Name *
Organization Phone * This should be the primary phone number associated with your organization.
Organization Email *
Organization's Website or Social Media Profile
Name of Contact regarding this Application *
Contact Phone (if different from above) This should be the phone number we should call regarding this application, if different from the organization's main phone number.
Contact Email (if different from above)
Address * Please enter your organization's mailing address. Multiple lines are allowed.
City *
State *
Zip Code *
Does your organization have a current license with the Department of Ag for Rescue? *
Please tell us about your organization's Adoption Program
What requirements does your organization have for placing an animal for adoption? (select all that apply) *	Fully Vaccinated Microchipped Altered Pass Behavior Assessment Medical treatments complete None of the above
How many adoptions does your organization process in a 12 month period?
What is your return policy for animals adopted from your organization?
Are all microchips registered once an animal has been adopted?
Are there circumstances where you would deem an animal as non-adoptable?
If your organization does classify some animals as not adoptable, how does it deal with them?
How does your organization handle animals with behavior issues?
Does your organization have an active foster program?
Please tell us about your organization's process for receiving animals.
For any required vetting, is your rescue willing or able to compensate? HSSI would provide receipts for expenses incurred for veterinary services.
Does your organization have transportation options?
Mark all fields required to pull a dog	Zero testing required Heartworm Negative Only Heartworm Positive Acceptable Parvo\Distemper Vaccination Bordetella Vaccination Rabies Vaccination Health Certificate Heartworm\Flea\Tick Prevention Capstar Deworming
Mark all fields required to pull a cat	No Testing Required FiV/FeLV Negative Only FiV Positive Only FeLV Positive Only FVRCP Vaccination Rabies Vaccination Health Certificate Flea\Tick Prevention Capstar Deworming

Humane Society of Southern Illinois | 95 Humane Road, Murphysboro, IL 62966 | 618-457-2362