MADACC Animal Placement Program

Partner Application

Milwaukee Area Domestic Animal Control Commission

3839 W. Burnham St.

West Milwaukee, WI 53215

 

 

The goal of MADACCís Animal Placement Program (MAPP) is to maximize and expedite the transfer of adoptable and potentially

adoptable animals to shelters and breed placement groups.  

 

Organization Information

Organization Name: ___________________________________________________________________

Address: __________________________________ City: ______________________   State: ________

Zip Code: _________________ Telephone __________________________ Fax: ____________________

Additional Business Locations: ____________________________________________________________

__________________________________________________________________________________

Email Address: ____________________________ Website Address: ______________________________

 

Type of Organization

List species, specific breed and/or mixed breeds that are accepted: ___________________________________

__________________________________________________________________________________

__________________________________________________________________________________

 

Number of:    Years in operation _______          Staff members _______            Volunteers _______

 

Geographic area covered: ________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

 

Facility Information

Type of Housing Offered: (check all that apply)                  Type of Services Offered: (check all that apply)

□  Foster Homes             □  Boarding at vet clinic              □  Breeder                     □  Referral

□  Indoor Kennels           □  Kennel/Cattery                       □  Rescue                       □  Transport

□  Outdoor Kennels         □  Other_________                 □  Foster                       □  Other_________

 

Does your organization have an animal age requirement and/or limitation?           Yes _____       No _____

If yes, please specify age requirement/limit: _________________________________________________

 

List capacity for:           Dogs __________              Cats __________               Other __________

 

Are there circumstances under which you would deem an animal to be non-placeable with the general public? 

 □ Yes     □ No     If yes, is euthanasia an option at your organization?   □ Yes     □ No   

 

Do you spay/neuter all animals before releasing to a new adoptive home?  If not, what animals do you release unsterilized and what

are your follow-up protocols to ensure sterilization? _____________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

 

What is your adoption fee and what services do you provide for that fee? ______________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Contact Information (Please complete for each person acting on behalf of the organization/agency. If more than four,

please provide additional names on a separate sheet of paper.)

 

Name: _____________________________________                      Name: __________________________________

Title: _____________________________________                        Title: __________________________________

Address: ___________________________________                       Address: ________________________________

City/Zip: ___________________________________                     City/Zip: ________________________________

Telephone: _________________________________                        Telephone: ______________________________

Fax: ______________________________________                       Fax: ___________________________________

Email: _____________________________________                      Email: __________________________________

Driverís License #: ___________________________                       Driverís License #: ________________________

Date of Birth: _______________________________                       Date of Birth: ____________________________

Name: _____________________________________                      Name: __________________________________

Title: _____________________________________                        Title: __________________________________

Address: ___________________________________                       Address: ________________________________

City/Zip: ___________________________________                     City/Zip: ________________________________

Telephone: _________________________________                        Telephone: ______________________________

Fax: ______________________________________                       Fax: ___________________________________

Email: _____________________________________                      Email: __________________________________

Driverís License #: ___________________________                       Driverís License #: ________________________

Date of Birth: _______________________________                       Date of Birth: ____________________________

 

Animal Shelter References (Please provide the name(s) of other shelters/agencies that also place animals in your care.   

If more than four, please provide additional names on a separate sheet of paper.)

 

Name: _____________________________________                      Name: __________________________________

Address: ___________________________________                       Address: ________________________________

City/Zip: ___________________________________                     City/Zip: ________________________________

Telephone: _________________________________                        Telephone: ______________________________

Fax: ______________________________________                       Fax: ___________________________________

Email: _____________________________________                      Email: __________________________________

Name: _____________________________________                      Name: __________________________________

Address: ___________________________________                       Address: ________________________________

City/Zip: ___________________________________                     City/Zip: ________________________________

Telephone: _________________________________                        Telephone: ______________________________

Fax: ______________________________________                       Fax: ___________________________________

Email: _____________________________________                      Email: __________________________________

 

 

Please attach a copy of the following documents:

 

1)       Organizationís Mission Statement and Program Policies

2)       Organizationís Adoption Contract

3)       Veterinary References

 

I ATTEST THAT INFORMATION IN THIS DOCUMENT IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

 

 

 

 

______________________________________________                _____________________________

Authorized Signature                                                                         Date

 

______________________________________________                 ______________________________

                           Printed Name                                                                                 Title

 

Please return the completed application to MADACC

Attention: Laura Proeber
Fax Number: 414-649-8651
Address:     MADACC
                    3839 West Burnham Street
                    West Milwaukee, WI  53215