Rescue Partner Application

The COPAW Rescue Partner Application
Rescue Partner Information and Application

Thank you for your interest in partnering with Central Ohio's Programs for Animal Welfare. Your efforts to join with us in support of the animals in our community are greatly appreciated! By becoming a Rescue Partner, we will save lives together!

Our Mission: Our mission is to improve the lives of as many animals as possible, while simultaneously supporting our community, through low-cost sterilization, vaccination, and wellness services, with an emphasis on outreach to under-served communities and rescue groups.

What We Do: COPAW assists both owned animals, as well as those currently being cared for by local shelters and rescues, through a variety of veterinary services, including:

· Operating low-cost canine and feline vaccine clinics for owned animals

· Operating low-cost spay and neuter clinics for owned animals

· Providing low-cost canine and feline vaccination services to shelters and rescues

· Providing low-cost spay and neuter services to shelters and rescues

· Operating a small-scale foster program

· Operating a small-scale animal sheltering program
How to Become a Rescue Partner

1. Complete the Rescue Partner Agreement Application, below. Must be reviewed and signed by your organization’s designated representative (Director/President/Board Member/etc.) before moving forward;

2. Provide copy of 501(c)(3) status, if applicable;

3. Review and approval can take up to 7 business days. You will receive status notification via email or regular mail (as applicable). The notification will include copies of related correspondence for your records.

Again, thank you for your interest and participation in this worthwhile program and for helping us help them!

If you have any questions, please email us at hello@copaw.org.
Rescue Partner Agreement Application

Please complete the form below to become a valued Rescue Partner!
It's great to meet you! Please tell us a little (or a lot!) about your organization.*
Has your organization been designated as a 501(c)(3)?*

YesNo, but our determination is pendingNo, our application was deniedNo, and we have not applied
Please Upload Proof of 501(c)(3) Status:

Browse Files

Cancelof
Organization Name*
Organization Address*

Street Address (P.O. Box not acceptable)

Street Address Line 2

CityState

Zip
Mailing Address (if different from above)

Street Address (P.O. Box not acceptable)

Street Address Line 2

CityState

Zip
Business Phone*
Business Email Address*
example@example.com
Website
Designated Representative Information

This person can act on the behalf of your organization in any, and all, circumstances.
Designated Representative Name*
Title*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Rescue Information
What type of animal(s) does your group rescue?*

CatsDogsRabbitsGuinea PigsOther Small MammalsReptiles
What type of organization are you considered?*

All-Breed Rescue GroupBreed Specific Rescue GroupSpecies-Specific Rescue Group
Description of organization type
Parameters

To help our staff work more expeditiously with you, we ask that you identify for us any particular parameters you may have when it comes to acceptance of an animal into your program.

As an example: Many shelters and rescues will accept any animal; some accept only a specific breed and may accept clear crosses of that breed. Others may have specific requirements (less than three years old; weigh not more than XX pounds; no injuries; etc.
Please indicate in the space below any parameters you may have: *
Authorized Contacts

By completing this section, you are authorizing the individuals named below to:

Act on your organization's behalf, including authorizing treatment plans and transactions, and/or transport animals between your organization's facility and our facility, on your organization’s behalf under the Rescue Partner Agreement. This information will be entered into our database for reference. We will ensure that only those individuals you authorize will be able to transport animals from our facility under your organization’s name. All information is confidential and is for departmental use only. Please select the shelter preferences, below, and use the definitions provided for reference.

Primary Contact: Can authorize treatment plans and/or transactions, as well as transport animals between your organization's facility and our facility.

Transporter Only: Is only responsible for bringing animals to our facility; is not authorized to transport animals from our facility.

Authorized Exit: Can transport animals to and from our facility.
Contact #1
Please Select All that Apply. This person is a:*

Primary ContactTransporter OnlyAuthorized Exit
Name (First and Last)*
Address

Residential Address (P.O. Box not acceptable)

Street Address Line 2

CityState

Zip
Cell*
Home
Work
E-mail*
example@example.com
Contact #2
Please Select All that Apply. This person is a:

Primary ContactTransporter OnlyAuthorized Exit
Name (First and Last)
Address

Residential Address (P.O. Box not acceptable)

Street Address Line 2

CityState

Zip
Home
Cell
Work
E-mail
example@example.com
Contact #3
Please Select All that Apply. This person is a:

Primary ContactTransporter OnlyAuthorized Exit
Name (First and Last)
Address

Residential Address (P.O. Box not acceptable)

Street Address Line 2

CityState

Zip
Home
Cell
Work
E-mail
example@example.com
Billing

Please indicate your billing preferences, below. All Rescue Partners will be provided with an estimate of the cost of services for each animal brought to our facility. Pricing can be viewed anytime at www.copaw.org/pricing.
Would you like to leave a card on file?*

YesYes, but we will provide this in-personNo
If you have selected 'No,' payment will be required at the time of services.
Name on Card
Card Number
Expiration Date

MonthDayYear
Date
Billing Zip Code
Notification will be given by email, 24 hours prior to processing a transaction via the card left on file. Special arrangements can be made for substantial balances incurred by patients requiring extensive care, but the request must be submitted in writing to hello@copaw.org prior to seeking care for the patient.
Partnership Agreement

Please read the agreement, below, and sign in the appropriate field to complete this application. Your signature on this form certifies that you have read, understand, and agree to the following agreement.
I, Your Name Here, designated representative of Your Organization Name, agree to the following terms, limitations and conditions of the Rescue Partner Agreement provided by the COPAW. I, the designated representative of my organization, understand that, if we are found to be in knowing violation of any of the below conditions at anytime, COPAW reserves the right to suspend and/or terminate our relationship. By signing this form, I acknowledge that I have read, understand, and agree to each of the following:
- Every Shelter and Rescue Partner must have submitted a completed application with the requested supporting documents and received written notice of approval from COPAW to participate in the program. Application alone does not qualify as approval.
- All Shelter and Rescue Partners agree to provide updated organizational information if requested by COPAW. COPAW also reserves the right to require current, approved Shelter and Rescue Partners to reapply if warranted.
- COPAW expects Shelter and Rescue Partners to make responsible decisions and to ensure the care of animals.
- COPAW does not, and will not, support or endorse animal training techniques using any method that involves excessive force or causes pain, fear, anxiety and/or stress.
- COPAW and the Shelter and Rescue Partners will strive to best meet the needs of the animals by working together in an honest and collegial manner.
- Any animal released to a Shelter and Rescue Partner must be spayed or neutered, when medically acceptable, prior to final placement by the Partner.
- Shelter and Rescue Partners must abide by all local, state or national laws with regard to their operations and shall not knowingly place an animal with a person or group that is in noncompliance with local animal control and licensing codes.
- COPAW values the lifesaving contributions made by our placement partners. We believe strongly that more animals will be saved when our communication and collaboration is positive and constructive. COPAW wants to avoid inaccurate negative attention that will create artificial barriers to shelter adoption, volunteer engagement, and public utilization of COPAW's services. We aim to inspire the community to join with us, and our partners, to save more animals. To that end, we ask that you join us in committing to the following:
a. COPAW and partners will clarify and respect proper chain of command for efficient communication.
b. Questions and concerns will be welcomed by both parties, according to the agreed upon chain of command.
c. Questions and concerns will be presented respectfully and responses will be prompt and equally respectful.
d. COPAW and partners will consider the impact of their public discourse and each other and will consider input that is in the best interest of the partnership. Unprofessional or negative public discourse, in venues such as online posting, may be grounds for cessation of partnership.
The Rescue Partner identified below acknowledges receipt of the above policies and agrees to be bound by them.
Organization Name*
Designated Representative*
Title*
Designated Representative Signature*

Clear
To be signed only by the designated representative within the rescue organization.
Should be Empty:

The COPAW Rescue Partner Application

Rescue Partner Agreement Application

Designated Representative Information

Rescue Information

Contact #1

Contact #2

Contact #3

Billing

Partnership Agreement