Animal Disaster Aid Research Form

• To use this form, you are a KINSHIP CIRCLE VOLUNTEER authorized by a Kinship Circle representative.
• You've been assigned disaster-related circumstances to research via Internet, phone, email...

Kinship Circle Animal Disaster Aid Network formed in 2005, after Hurricane Katrina left tens of thousands of animals stranded. Today we mobilize volunteers, supplies and resources for animal victims through our network of trained responders. Kinship Circle may work under agreement to deploy volunteers to a disaster one, or manage volunteers for another organization on the ground. READ: About Our Volunteer Network

SEE SECTIONS A TO H BELOW. You're not expected to complete all sections, but please fill in as much as possible. Kinship Circle reserves the right to use, edit, and/or reject submitted information.

A. YOUR VOLUNTEER CONTACT INFO B. DISASTER TYPE / DATE / LOCATION C. ANIMAL VICTIMS IN THIS DISASTER D. ANIMAL-RESPONSE OFFICIALS

E. SHELTER, GROUP...THAT NEEDS AID F. SUPPLIES & DONATIONS NEEDED G. VOLUNTEERS NEEDED H. TO REPRESENT KINSHIP CIRCLE...

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A. YOUR VOLUNTEER CONTACT INFORMATION:

*First Name *Last Name   Phone Numbers   *Email   **If we do not have your complete volunteer contact information on file, please fill out our General Volunteer Form.

Kinship Circle uses your contact information privately to maintain its volunteer list. Do you want to be credited for your work with your name + email addresss listed on the published alert itself? Yes    No

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B. DISASTER TYPE, DATE, LOCATION:
1) BASIC INFORMATION ABOUT THIS DISASTER ZONE — Answer to the best of your ability.

Disaster Type
Dates
Affected States
County			Cities
County			Cities
County			Cities
County			Cities
County			Cities
County			Cities
County			Cities
County			Cities
LIST ADDITIONAL AFFECTED COUNTIES — AND CITIES WITHIN THOSE COUNTIES — HERE

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C. ANIMAL VICTIMS IN THIS DISASTER

1) TYPES OF ANIMALS AFFECTED BY THIS DISASTER — Select each category that applies.
Domestic Animals    Farm Animals    Wild Animals    Exotic Animals
Other Category:

2) ANIMAL DISASTER EVENTS — Summarize situations you're aware of. List links to your source! FOR EXAMPLE: •Reports of stranded cows and horses in Plaquemines Parish, New Orleans. Here are links to stories: http://www.animalsunderwater.com, http://www.neworleansdailynews_flooding_animals.com •Organize/condense any emailed information and paste contents here, with original sender's name/email.

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D. STATE, COUNTY, COMMUNITY ANIMAL-RESPONSE AUTHORITIES
1) ANIMAL RESPONSE OFFICIALS — Enter all emergency management contacts you can locate.

	SEMA AND FEMA CONTACTS — STATE & FEDERAL EMERGENCY MANAGEMENT
Name/Title	Phone
Email	Address + More Info
Name/Title	Phone
Email	Address + More Info
	STATE VETERINARY RESPONSE COORDINATOR (DEPT. OF AGRICULTURE)
Name/Title	Phone
Email	Address + More Info
	STATE VETERINARIAN, ASSISTANT STATE VETERINARIAN (DEPT. OF AGRICULTURE)
Name/Title	Phone
Email	Address + More Info
Name/Title	Phone
Email	Address + More Info
	MORE EMERGENCY OPERATIONS CENTER (EOC) CONTACTS
Name/Title	Phone
Email	Address + More Info
Name/Title	Phone
Email	Address + More Info
	LOCAL LAW ENFORCERS — POLICE DEPARTMENT AND/OR SHERIFF'S OFFICE
Name/Title	Phone
Email	Address + More Info
Name/Title	Phone
Email	Address + More Info
	STATE & COUNTY ANIMAL RESPONSE TEAMS (SART & CART)
Name/Title	Phone
Email	Address + More Info
Name/Title	Phone
Email	Address + More Info

ADDITIONAL ANIMAL-RESPONSE OFFICALS, INCLUDING NGOS (NON-GOVERNMENT AGENCY)
Along with any more government contacts, list animal group contacts (EARS, IFAW, Noah's Wish, etc that are on the ground.

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E. SHELTER, GROUP OR AGENCY THAT NEEDS ASSISTANCE

1) NAME OF SHELTER, GROUP OR AGENCY THAT NEEDS HELP


2) GROUND CONTACTS — Name, Title/Phone Numbers/Email — for each contact
FOR EXAMPLE: Sarah Smith, Shelter Operations Director: 123-456-7890, sarahsmith@shelter.org

3) WEBSITE ADDRESS — Shelter, Group or Agency's Website URL (link)


4) PERMANENT SHELTER LOCATION — Street Address/City/State/Zip (even if evacuated)
    EMERGENCY SITE WITH EVACUATED ANIMALS — Street Address/City/State/Zip
FOR EXAMPLE: PERMANENT LOCATION: Group's Name / 12123 Maple Street / Anytown, Anystate 01234 EMERGENCY SITE: Group's Name / 45456 Oak Street / Anycity, Anystate 56789 Type DIRECTIONS to location conducting emergency animal operations after addresses

5) SUMMARY OF SITUATION — How has the disaster affected animals and this shelter/agency?
FOR EXAMPLE: • People evacuations and how they will impact animal surrenders or abandonment • Deaths or injuries • Water, fire, land or other ongooing rescue • Estimated animal count at emergency shelter... ETC.

6) PHOTOS — Website addresses (URLs) to any related photos

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F. SUPPLIES & MONETARY DONATIONS NEEDED

1) SUPPLY LIST — List each needed item, line by line.
FOR EXAMPLE: - Wet Dog Food, Wet Cat food - Dry Cat food - Veterinary Meds - Frontline, Vaccines, Clavamox, Alvox (diarrhea), Flagil, KMR Formula (bottle fed cats) - Wire Crates (large and medium size - 200 Qty)... ETC...

2) SHIP SUPPLIES TO — ATN: Person's Name/Group's Name/Address/City, State, Zip
    DROP OFF SUPPLIES AT — ATN: Person's Name/Group's Name/Address/City, State, Zip
FOR EXAMPLE: SHIP TO: Person's Name / Group's Name / 12123 Maple Street / Anytown, Anystate 01234 DROP OFF: Person's Name / Group's Name / 45456 Oak Street / Anytown, Anystate 56789 If you have DIRECTIONS to supply drop location, type them after the addresses.

3) MONETARY DONATIONS — Mailing Address & Online Link Where Donations Are Made FOR EXAMPLE: MAIL DONATIONS: Shelter/Group Name / 12123 Maple Street / Anytown, Anystate 01234 DONATE ONLINE: www.donatetohelpanimals.org

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G. VOLUNTEERS NEEDED

1) KINSHIP CIRCLE'S ROLE IN THIS DISASTER — Select answer that applies.
VOLUNTEER MANAGEMENT: recruit/deploy volunteers; communicate with ground contacts.
MANAGE STANDBY LIST: Recruit and maintain standby volunteers for another agency.
REPORT ONLY: Research/report volunteer, supply and monetary needs for animals.

2) TYPES OF VOLUNTEERS NEEDED — Select each answer that applies

Search & Rescue    Field Assessments Veterinarian/Vet Tech/Medical Experience Admin (computer, phone, organizing) Animal Adoption & Transport Coordinators Runners (to pick up/deliver supplies)		Food/Water Stations In The Field Emergency Shelter Care Supply Coordinator Animal Transport (experience required) Construction Experience
OTHER

3) WHO DO VOLUNTEERS REGISTER WITH? — Volunteers must sign-up, not just show up.

	Primary Contact			Secondary Contact
First/Last Name			First/Last Name
Title			Title
Organization			Organization
Email Address			Email Address
Phone Numbers			Phone Numbers
	Third Alternate Contact			Fourth Alternate Contact
First/Last Name			First/Last Name
Title			Title
Organization			Organization
Email Address			Email Address
Phone Numbers			Phone Numbers

SPECIFIC INSTRUCTIONS FOR VOLUNTEERS:
FOR EXAMPLE: • Volunteers: Email contact info and available dates to coordinator (or Kinship Circle) to be on a standby list. • Volunteers: Call primary contact above to schedule shifts at the emergency site. • Any other specific procedure for volunteers

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H. GENERAL SCRIPT TO USE, WHEN REPRESENTING KINSHIP CIRCLE
      To represent Kinship Circle if you speak to a local/state agency or another animal response group (NGO)
      — CLICK BUTTON to view and copy a general script. MUST MODIFY to represent situation at hand!

TYPE DATE Dear [person or group's name], I write on behalf of Kinship Circle Animal Disaster Aid. We are a nonprofit animal advocacy group that offers support on the ground or remotely to assist with your rescue and emergency sheltering efforts. Independently trained and credentialed volunteers in our network are prepared to work under the command structure of emergency services presently in charge. We network resources for animal disaster victims, including monetary donations, supplies, and volunteers as needed. We can activate our nationwide database if you need backup. Kinship Circle volunteers reflect a wide range of disaster training and professional expertise. Kinship Circle has worked under agreement with Iowa's Veterinary Response Team within the Department of Agriculture during Midwest floods — deploying volunteers to emergency shelters in Southeast Iowa. We have coordinated volunteers for pre-evacuations during Hurricane Gustav and shelter opertions in the aftermath of Hurricane Ike. We are among the founding coordinators of Animal Rescue New Orleans, a rescue and care operation situated in New Orleans after Hurricane Katrina from 2005 to 2006. FOR MORE INFORMATION, SEE: www.kinshipcircle.org/disasters/volunteer/about.html If we can support your efforts, contact us any time. YOUR NAME, Disaster Aid Coordinator, Kinship Circle YOUR EMAIL YOUR PHONE NUMBER Brenda Shoss, President, Kinship Circle info@kinshipcircle.org cell: 314-795-2646; desk: 314-863-9445 Terri Kelley, Disaster Aid Coordinator, Kinship Circle pawsitivedirections@yahoo.com 765-274-9601 KINSHIP CIRCLE ACTION CAMPAIGNS * EDUCATION * ANIMAL DISASTER AID NETwORK www.KinshipCircle.org * www.kinshipcircle.org/disasters

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