MUSKINGUM COUNTY DOG
RESCUE ADOPTION SERVICES APPLICATION
740-453-0273
NO DOGS FOR LABORATORY RESEARCH
Date____________________
Name of breed rescue___________________________________________
Address______________________________________________________
City_____________________State_______________Zip______________
Telephone Number_____________________________________________
e-mail of breed rescue_____________________
Two Authorized Contacts: (Please Print)
Contact #1____________________________________________________
Address______________________________________________________
City_____________________State_______________Zip______________Telephone________________e-mail_______________________________
Contact #2____________________________________________________
Address______________________________________________________
City_____________________State_______________Zip______________
Telephone________________e-mail_______________________________
AUTHORIZED SIGNATURES:
Contact#1______________________________________Date__________
Contact#2______________________________________Date__________
MUSKINGUM COUNTY DOG
RESCUE ADOPTION SERVICES RULES
740-453-0273
NO DOGS FOR LABORATORY RESEARCH
1. Application must be completed.
2. Tags purchased and fees paid.
3. Fees subject to change.
4. Transportation must meet approval of Muskingum County.
5. Within one week of pick up of rescued dog:
A. Location reported
B. Telephone number of owner
C. Telephone number of local Human Officer
6. Time limit of one week is enforced for removal of rescue.
7. Terms will be strictly enforced or contract will be terminated.
Contact#1______________________________________Date__________
Contact#2______________________________________Date__________