Second Chance Partner Request Form

You are also welcome to email Second Chance staff at [email protected] if you have questions prior to beginning this form. We understand this form may be extensive for some organizations, and we are open to feedback.

Name of Organization:*

Address*

Street Address City State / Province / Region

Website or web presence (i.e. social media):

How would you classify your organization?*

Nonprofit (primarily shelter based)
Nonprofit (primarily foster based)
Municipal Organization
Transport Specific Agency

If nonprofit, is your organization currently classified as a 501c(3)?

Yes
No

Please provide your EIN number:*

Is your organization seeking 501c(3) status? When do you expect this to be completed?*

Name and title of shelter leadership (executive director, operations director, or shelter manager):*

Shelter Leadership Email*

Shelter Leadership Phone:*

Before submitting this request form, please read the Second Chance Transfer Eligibility and Vaccination Agreement.

After reading the Second Chance Transfer Eligibility and Vaccination Agreement, do you have any questions or concerns?*

Does your organization have a veterinarian or registered veterinary technician on staff?*

Yes
No

Name and Title*

Phone Number*

Email*

Do you work with a veterinarian in your community?

Yes
No

Veterinarian's Name*

Veterinarian's Number*

Veterinarian's Email*

Does your organization have the ability to spay and neuter onsite?*

Yes
No

Do you have a dedicated transport contact at your organization?

Yes
No

Transport Contact's Name:*

Transport Contact's Title:*

Transport Contact's Email:*

Transport Contact's Number:*

If no, what is the best way to reach you?*

What kind of animals are you looking for assistance with? (Check all that apply)*

Dogs of all kinds
Large dogs (50 lbs +)
Dogs with behavior concerns
Cats of all kinds
Adult cats
Kittens
Other

If other, please list animals:*

Do you vaccinate on intake?*

Yes
No

What vaccinations are given? (i.e. DA2PP, Bordetella)*

If no, what is your organization's vaccination protocol?*

Please describe any other preventative health protocols in place at your organization.

What health issues do you screen for regularly? (i.e. fecals, Felv, FIV, HW, Parvo)*

What common infectious diseases does your organization see commonly?*

What type of disinfectant does your organization use?*

Is your staff able to identify upper respiratory infection symptoms in felines and canines?*

Yes
No

Is your staff able to screen for ringworm on felines and canines?*

Yes
No

Does your organization have the ability to treat ringworm?*

Yes
No

Is your organization able to provide medical documentation and behavior information for animals nominated for transport?*

Yes
No

Is your organization able to provide video of dogs (if requested) prior to transport?*

Yes
No

Do you conduct canine behavior assessments at your organization?*

Yes
No

What style of assessment do you use? (i.e. Organization specific, SAFER, Match-Up II, Assess-a-Pet)

Would you be willing to provide a blank example of your behavior assessment for our records?

Yes
No

Please upload the blank behavior assessment file here:

Max. file size: 20 MB.

Are you able to discuss kennel presence, handling, or other behavior if requested?*

Yes
No

Does your organization have the ability to fill out transport manifests using Excel or Google Docs?*

Yes
No

Is your organization able to provide transport to OHS?*

Yes
Third Party Transport (i.e. ASPCA Relocation)
No, transport assistance needed.

What type of vehicle do you use?*

What kind of climate control do you use during transport?*

Due to transport guidelines, the Oregon Humane Society avoids long distance transport over 11 hours. If your organization is not within 11 hours of the Oregon Humane Society, transport feasibility may need to be discussed. Even if you are outside these guidelines, please continue filling out this form.

Do you work with any other organization in Oregon or Washington?*

Yes
No

Would you be able to provide any references for your organization? (Please include them below)*

If you could solve one problem in your community, what would it be?*

More access to spay and neuter services.
Training or education for community members.
Resources for owners to keep their pets.
Assistance for animals with medical concerns.

Second Chance Partner Request Form

Please Note

Second Chance Partner Request Form

Before submitting this request form, please read the Second Chance Transfer Eligibility and Vaccination Agreement.