Public Safety - Animal Care and Control

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Palm Beach County Animal Care & Control (PBCACC) is responsible for the laws that protect animals and residents in our community, sheltering neglected, stray, and surrendered pets, returning stray pets to their owners and promoting responsible pet ownership. Some of the animals who come to our shelter may need medical or behavior rehabilitation beyond the scope of our resources. By working with other animal rescue organizations (Placement Partners), PBCACC can offer these animals a second chance at recovery and the opportunity to find an appropriate home.

Thank you for taking the time to complete this form; the information you provide will be used to best match animals in our care with your organization.

An approved Placement Partner application must be on file prior to the release of any animals to your organization.

All of our Rescue Requests are made via email. Once your application is approved, we will add you to our contact list and begin emailing you as animals are in need of rescue.

Please include at least two key email addresses where you would like to receive our Rescue Requests.

Please include up to two key email addresses that you will use for your profile on our new “Rescue – SNAP” database as well as for us to send rescue requests to. The emails must match to gain access to “Rescue – SNAP” and our email distribution list.

Email 1: *This question is required. This question requires a valid email address.

Email 2: *This question is required.

General Information

Name of Organization: *This question is required.

Tax-Exempt ID#: *This question is required.

*Please attach a copy of your 501C3 paperwork: *This question is required.

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Location:

Physical Address:

Street Address:

City:

State:

Zip

Mailing Address:

Street Address: *This question is required.

City: *This question is required.

State: *This question is required.

Zip: *This question is required.

Website:

Social Media:

Email Address: *This question is required. This question requires a valid email address.

Phone Number: *This question is required.

Fax Number:

Veterinarian Name & Clinic:

Business Name: *This question is required.

Street Address: *This question is required.

City: *This question is required.

State: *This question is required.

Zip: *This question is required.

Phone Number: *This question is required.

Animal Services/Animal Control Agency for your County (applies to rescues outside of Palm Beach County):

Business Name: *This question is required.

Street Address:

City:

State:

Zip:

Phone Number: *This question is required.

Contact Information
We will only release animals to contacts listed on this application. Please contact us if updates need to be made.
Primary Contact Information

Contact: *This question is required.

Title: *This question is required.

Email: *This question is required. This question requires a valid email address.

Zip: *This question is required.

Phone Number: *This question is required.

Can authorize transport, animal pickup, and organization updates?

Yes
No

Rescue Specifics

What type of pets do you accept (dogs, cats, reptiles, etc.)? *This question is required.

Are you a breed-specific rescue? *This question is required.

Yes
No

Breed(s) *This question is required.

Are mixes of these breeds accepted? *This question is required.

Yes
No

If not breed-specific, are there specific types of pets that you focus on (small breed, seniors, puppies, kittens, etc.)?

How many animals do you typically adopt out in a year? *This question is required.

What is the average length of stay for animals in your care? *This question is required.

day(s)

Under what circumstances would an animal in your care be euthanized and by whom? *This question is required.

Are you able to accept animals with behavioral problems? *This question is required.

Yes
No

If yes, please specify what behaviors you are able to handle: *This question is required.

If yes, who?

Full Name: *This question is required.

Address: *This question is required.

City: *This question is required.

State: *This question is required.

Zip Code: *This question is required.

Phone Number: *This question is required.

Please note, your organization is responsible for all medical treatment and related costs upon possession of the animal. Our agency may require documentation from your veterinarian regarding proof of treatment.

Placement Partner Commitment

1. Applications will be renewed and updated annually. Applications will include a legible copy of the
organizations 501c3 designation for PBCACC records. *This question is required.

2. The organization agrees to remain in compliance with all federal, state, and county animal laws.
And shall maintain any/all such licenses and certifications as are necessary to operate a 501c3
rescue organization. *This question is required.

3. The organization agrees to an inspection of their animal housing facilities (as needed) by an
official representative of PBCACC. *This question is required.

4. The organization will designate individuals who are authorized to arrange payment, transport and pickup of animals. Animals will only be released to the approved organization members listed on the application. If authorized members change, please email us at ACCRescueRequest@pbcgov.org *This question is required.

5. The organization will not hold PBCACC responsible for the cost of any outside veterinary care or damages incurred after the animal has been released to the organization’s custody. The organization shall not hold PBCACC, its employees, volunteers, or officials responsible for any liabilities, claims, suits or demands which may be incurred as a result of any act or mission committed and performed under the terms of this agreement by the organization or anyone under agreement with the organization. *This question is required.

6. If not done so before the time of release, the organization is responsible for the spay or neuter of animals in their care, before final placement or adoption. Proof of spay/neuter must be submitted to PBCACC promptly. *This question is required.

7. The organization understands that PBCACC cannot guarantee the health, temperament, or estimated age of the animal; the organization takes on full responsibility for any illness transmitted to other animals in their care. *This question is required.

8. The organization will meet the minimum standard of animal care for housing, nutrition, medical care, and socialization appropriate to the species and in compliance with all county housing requirements. *This question is required.

9. The disposition of the animal and the current owner information must be forwarded to PBCACC within 30 days of placement in a permanent home by the organization. For reference, please see requirements here. *This question is required.

10. The organization will comply with Sec. 4-26 Animal agencies of Palm Beach County Ordinance 98-22. Including, reporting the number of animals (by species) shelter, adopted and in foster. *This question is required.

11. In the event the organization takes custody of an animal involved in an open investigation the organization agrees to comply with all reasonable requests from PBCACC for updates pertinent to the investigation. *This question is required.

12. The organization agrees to arrange pickup of any animal they are committing to within 48 hours of initial contact to PBCACC. *This question is required.

13. The organization understands that the adoption or rescue pull fee may vary based on status of the animal and services provided to the animal by PBCACC *This question is required.

14. The organization agrees to abide by the decision of PBCACC in regards to an animal’s eligibility to be released to a Placement Partner. PBCACC will not knowingly release any animal that poses a threat to safety of the public or to other animals. In the case of an animal that has a history of behavioral concerns, or demonstrates behavioral concerns, PBCACC will disclose such information to the Placement Partner and will only make that animal available to organizations with expertise in such behavior issues. *This question is required.

15. The organization understands that PBCACC reserves the right to deny placement of an animal at their discretion. *This question is required.

16. The organization understands that this agreement can be terminated by either party at any given time for any reason. *This question is required.

Commitment of Palm Beach County Animal Care & Control

Palm Beach County Animal Care & Control is committed to the following:

Informing the organization of their approval or denial as a Placement Partner in a timely manner. PBCACC reserves the right to deny any application - the organization will receive email notification regarding denial of the application
Providing instruction on changes to policy, procedure, or county ordinance that may impact the organization.
Providing a copy of all medical records, x-rays, and behavioral information to the Placement Partner upon release of the animal.
Providing support and maintain open communication with the organization. PBCACC will be available to the organization and willing to discuss concerns.
Providing pertinent information about an animal that will enable the organization to make an informed decision as to whether or not to accept the animal into their care.
Spaying/Neutering all animals (if medically able) prior to release from PBCACC.

PBCACC understands that this agreement can be terminated by either party at any given time for any reason.

I agree that I have the authorization to enter into this agreement on behalf of the 501c3 Organization listed below, and that I have read and agree to all policies outlined in this agreement. I understand that I assume full responsibility for the well-being of the animal while under my organization’s care. I agree that I will conduct due diligence and otherwise make my best effort to place any animal(s) obtained from Palm Beach County Animal Care & Control in a safe and healthy environment, and I further agree that I will not knowingly place an animal into an environment where it may harm a person or another animal. I understand that failure to comply with these policies may result in the organization’s removal as an approved Placement Partner.

Signature *This question is required.

Clear

Signature of

Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Print Name and Official Title *This question is required.

Name of Organization *This question is required.

Drivers License Photo: Allowed types: png, gif, jpg, jpeg, pdf. Max file size: 500 KB. *This question is required.

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Adoption policies and guidelines: Allowed types: pdf. Max file size: 500 KB. *This question is required.

File: {{filename}} delete

Adoption contract: Allowed types: pdf. Max file size: 500 KB. *This question is required.

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Adoption Fee Schedule: Allowed types: pdf. Max file size: 500 KB. *This question is required.

File: {{filename}} delete

E-mail Disclaimer:

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

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Public Safety - Animal Care and Control

Placement Partner Application