Animals' Disaster Team - Helping Your Pets When It's Needed the Most
ADT RESOURCE QUESTIONNAIRE
 
 
 
DATE ________________________           COUNTY  _____________________
 
 
The following information explains what resources I can provide as a member of the ADT:
 
 
I can assist in the rescue/capture of the following:
 
 
Dogs  _____   Cats  _____                 Birds  _____   Aquatics  _____   Reptiles  _____   Horses  _____   Wildlife  _____
 
 
Small critters  _____   Small Livestock  _____    Large Livestock  _____   Poultry  _____   
 
 
Other (Please list)  ___________________________________________________________________________ 
 
 
I can provide temporary, safe shelter and foster care for the following:
 
 
Dogs  _____   Cats  _____                  Birds  _____      Aquatics  _____   Reptiles  _____    Horses  _____   Wildlife  _____
 
 
Small critters  _____   Small Livestock  _____   Large Livestock  _____   Poultry  _____   
 
 
Other (Please list)  ____________________________________________________________________ 
 
 
Please describe the shelter available  __________________________________________________
 
 
I can provide transportation to help evacuate animals.
 
 
Describe type of transportation available.  _______________________________________________
 
 
I can provide the following equipment on loan to the ADT:
 
 
Cages  _____  Carriers  _____  Traps  _____   Nets/lures  _____  Fans  _____  Heaters  _____
 
 
I can provide the following needed supplies as a donation:
 
 
Bedding  _____ Towels  _____  Food  _____  Paper towels  _____  Cleaning items  _____ 
 
 
I can provide Medical assistance. My training __________________________________________
 
____________________________________________________________________________________________ 
 
 
I can provide:  Clerical assistance  ___   I can make phone calls _____  Access to computer ____ 
 
Other assistance 
 
_________________________________________________________________ 
 
I can swim  _____    Other training includes:  ______________________________
 
_________________________________________________________________
 
 
--------------------------------------------------------------------------------------------------------------------------------------------   
 
 
NAME _______________________________________________________________________________________ 
 
 
ADDRESS  _______________________________________________CITY/ZIP _________________________
 
 
REGION  ___________________________________            DAY PHONE _____________________________
 
EVENING PHONE  ___________________________             PAGER _________________________________
 
 
CELL PHONE  _______________________________           OTHER PHONE __________________________
 
 
EMAIL ______________________________________
 
 
ADT/Form 101-Resource Questionnaire-rev 2/07-white
 
 
 
 
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