325 Columbia Turnpike, Florham Park, NJ 07932 1-877-538-6300

Animal Shelter Application

Animal Shelter Application

Name of Organization:
Date organization began: Phone:
Fax: Mailing address:
City: State: Zip Code:
Email Address:
Website Address:
How many kennels, cages, or compartments do you have on premises?
How many dogs are on premises?
How many cats are on premises?
Do you shelter large, wild or exotic animals? Yes No
If yes, please specify:
If you operate any of the following, provide annual sales: Gift Shop Pet Training Pet Grooming
Annual Sales:
Does the organization accept aggressive animals? Yes No
If yes, how do you assess:
Does the organization use foster homes? Yes No
If yes, how many annually?
Is there a contract including a hold harmless waiver in place for each foster? Yes No
If you do not have a hold harmless waiver contract, please see: Foster/Volunteer Waiver Form
Does the organization provide onsite adoptions? Yes No
If yes, how many annually.
Does the organization hold off site adoption events at other locations adoptions? Yes No
How many per year?
Is there a contract including a hold harmless waiver in place for each adoption? Yes No
If you do not have a hold harness waiver contract, please see: LINK HERE
Do you have a procedure for reporting and documenting incidents? Yes No
If you do not have incident reporting procedures see: Incident Report Form
Are there any animal control activities as part of your organizations operations? Yes No
If yes, please explain.
Does this person have arrest or seizure authority? Yes No
If yes, your organization will be excluded.
Does this person carry a firearm or Taser? Yes No
If yes, your organization will be excluded.
The undersigned certifies that all answers provided are true, correct and complete to the best of their knowledge.
Applicant Name: Title:
Phone: Email:
Date: 09/26/2017