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2. Thank you for your interest in helping shelter pets at Orange County Animal Services in Chapel Hill, North Carolina.

4. 
6. Name of Organization:*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Mailing Address (if different from above, please provide full mailing address here including street address, city, state, and zip code):
16. Phone:*
17. Email:*
19. Primary Contact Name:*
21. Primary Contact Email:*
23. Driver's License/Photo ID Number*

    A government-issued photo ID is required to release any animal. Please list the TYPE (driver's license, passport, military ID card, etc.), STATE, and ID NUMBER.

25. Secondary Contact Name:
26. Secondary Contact Email:
28. Is this organization a registered 501(c)3 non-profit?*
    -- Select One --YESNo
29. 501(c)3 Proof

    Please upload your 501(c)3 letter here! If you are unable to attach it here, you may email it to foster@orangecountync.gov.

31. What breed(s) and/or type(s) is placement provided for?*
33. Are mixes of these breeds accepted?*
    -- Select One --YESNOMAYBE (see comments)
34. Will the organization consider taking in animals with medical conditions?*
    -- Select One --YESNOMAYBE (see comments)
36. Will the organization consider taking in animals with behavior problems?*
    -- Select One --YESNOMAYBE (see comments)
37. How does the organization house animals?*
    -- Select One --FOSTER HOMESA FACILITYFOSTER HOMES & FACILITYBOARDING KENNEL (please list any boarding kennels in comments section below)
39. Please list the veterinary clinic(s) your organization uses:
41. What is the organization's long-term plan for animals not adopted?*
43. Comments:
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field