Shelter – Recipient Application

This is an application for animal shelters to apply for donations from the GOODS Program, distributed through Cody’s Friends Charity.

Donors provide wholesome, nutritious food on an as-available basis only. Recipient organizations are not able to request specific food types (e.g., grain-free) or brands. Food and supplies (the “Donated Goods”) are for the Recipient Group’s use only. They may not be: a) redistributed without the expressed written consent from the GOODS Program, b) sold, rented, or exchanged for other goods or services, nor c) presented for refund.

Each Recipient Organization must complete their own application. Submitting this form does not guarantee approval to receive products. Incomplete applications will not be processed.

Organization Name *

Mission Statement *

Website *

Link to adoptable animals *

Direct link required. Please don't just put the word "Petfinder" or "www.petfinder.com".

Facebook Page

Twitter Account

Non-profit and/or Federal Tax ID # *

Please upload a copy of your IRS Determination Letter. *

Address (No PO Boxes) *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Completed by *

First

Last

Applicant's Position in Organization *

Phone *

Animals Reside in: *

• Foster Homes
• Facilities
• Both

# of dogs adopted in last 12 months *

Average monthly need for dog food (lbs) *

# of cats adopted in last 12 months *

Average monthly need for cat food (lbs) *

Describe food storage capabilities - please include maximum food storage capacity. *

Do you spay/neuter all animals prior to adoption? *

• Yes
• No

If you answered no to the above question, please explain why.

Does your organization have a contract to provide Animal Control Services for any city, county or municipality? If yes, please explain. *

Describe Adoption Programs *

# of Employees

# of Active Volunteers

Does the shelter currently participate in a manufacturer sponsored "shelter feeding program"? *

• Yes
• No

If you answered yes, please provide program name and frequency.

Has the shelter received "donated" or "low cost" pet food within the past twelve (12) months? *

• Yes
• No

Please list any other pet food sources. *

Veterinary Reference - please provide contact information *

Shelters must provide a Rescue Group reference. Please include contact information *

Why is your organization requesting support from the GOODS program? *

If applicable, please provide the top four (4) non-profit rescue groups you allow to pull from your shelter.

Please list your Board Members' names and email addresses or phone numbers. *

Authorized Representatives - Please provide at least two (2) individuals.

Person #1

Full Name *

Position in Organization *

Email *

Phone Number *

Person #2

Full Name *

Position in Organization *

Email *

Phone Number *

Person #3 (optional)

Full Name

Position in Organization

Email

Phone Number

Person #4 (optional)

Full Name

Position in Organization

Email

Phone Number

By submitting this application you agree and acknowledge the following terms and conditions:

1. You are authorized to sign this agreement on behalf of this organization and certify that the information set forth in this application and supporting documentation is correct. 
2. You have read and understood the criteria that apply to this application and certify that the group meets each one.  
3. The IRS determination letter has not been revoked, canceled or modified. 
4. That food shall be protected against dampness, deterioration, and mold or from contamination by insects, birds, rodents or other animals.
5. That food spoiled or otherwise contaminated shall not be served. 
6. To abide by restrictions or conditions of distribution, if any, imposed by the source of Donation and communicated to Recipient by Donor. 
7. Any raw meat provided is not fit for human consumption and shall be used solely for feeding animals.
8. That feeding pet food to ruminant animals is prohibited. 
9. To not sell, transfer, trade or barter any Donation or portion thereof in exchange for money, property or services or otherwise allow the items to enter commercial channels.
10. To release both Donor and Donor’s source(s) from any liability arising from the condition of Donation and further agrees to indemnify and hold harmless Donor and its source(s) against any and all damages, losses, claims, causes of action and suits of law or in equity or any obligation whatsoever arising out of or attributed to any action of in connection with Recipients receipt, handling or distribution of Donation.
11. That the GOODS program may list your organization as a participant in its publications, website or other informational materials but will not sell or disclose non-contact information for any commercial purpose.
12. That goods or services are provided on an "as is" and "as available" basis. The GOODS program expressly disclaims all warranties of any kind, whether express or implied, including, but not limited to the implied warranties of merchantability or fitness for a particular use or purpose.
13. Your organization grants to the GOODS program the following: 1) the right to include on its website a link to your organization’s website(s), 2) the right to use any image(s) that you submit to the GOODS program or that may be recorded by the GOODS program during or in connection with events that involve both organizations.
14. Permit monitoring, including a site visit if requested, by a Donor representative, as reasonable and necessary to verify that compliance with criteria, receipt, handling and use of Donation conform to this Agreement.
15. Applicant will allow onsite inspection by GOODS program representatives within a reasonable period of time (not to exceed 7 days) after request for inspection is made.
16. Applicant grants permission to the GOODS program and its pet products donors to use information contained in this application for their internal evaluation and response procedures.
17. All Handling Fee payments are to be made payable to the Affiliate Organization or the GOODS program, as requested, and in no event made to any individual or other organization.

I have read and agree to the above terms and conditions. *

• Yes

Signature *

Personal Email *

Personal Phone Number *

Personal Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

How did you hear about this program? If you were referred, please list the name of the individual and/or organization. *

Submit Application