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: ______________________________
_________________________________________________________________
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NAME _______________________________________________________________________________________
ADDRESS _______________________________________________CITY/ZIP _________________________
REGION ___________________________________ DAY PHONE _____________________________
EVENING PHONE ___________________________ PAGER _________________________________
CELL PHONE _______________________________ OTHER PHONE __________________________
EMAIL ______________________________________
ADT/Form 101-Resource Questionnaire-rev 2/07-white
