The Humane Society of Jefferson County
Rescue Group Application
Name of Rescue Group:________________________________________________
Type of Animal Your Group is interested in rescuing:_________________________
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Mailing Address of Group: ______________________________________________
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Name of Main Contact Person:____________________________________________
Phone Number: Home:________________Work:_____________________________
E-Mail Address:_______________________________________________________
Please list the persons who are authorized to rescue from the Animal Shelter on behalf of your group:
Name:___________________________ Phone: _________________________
Name:___________________________ Phone:__________________________
Name: __________________________ Phone: __________________________
Do you have a website? Yes No URL:___________________________
May we list your web site on our links page? Yes No
Please list any limitations for rescue or any other information you think might be helpful ( example; no senior dogs).
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Please return this application and documentation described in the “ Guidelines for Rescue Groups” to:
Rescue Program
The Humane Society of Jefferson County P.O. Box 653 Jefferson City, TN 37760