Help the Jackson County Humane Society by hosting your own fundraising event.

1. Jackson County
Hum a n e S o c i e t y
Third Party fundraising events put the "fun" in "fundraising" and are hosted by individuals and
organizations external to the Jackson County Humane Society, yet benefit the shelter animals via
proceeds, donations and in other valuable ways. Please give enough advance notice so the Jackson
County Humane Society can help give you recognition and additional promotional support for your
event such as listing your event in our Upcoming Events Section on our website.
Feel free to come up with projects of your own too, but all projects must be approved first
Once you have a fundraising idea in mind.....
Please complete a “Third Party Fundraising Application”
Call us at 563-652-5360 for more information
We look forward to hearing from you!
for giving your time, energy and talent to to raise funds for the Jackson
County Humane Society! Your contributions directly touch animals’ lives.

2. Jackson County _________________
Date Submitted
Humane S o c i e t y
We appreciate your interest in raising funds to benefit the orphaned animals at the Jackson County Humane Society.
To help expedite your request and support your efforts, please complete both sides of this form and fax, mail or deliver it to the
Jackson County Humane Society. If you have any questions, please give us a call at 563-652-5360 ... Thank you!
“ACCEPTANCE OF THIS APPLICATION IS AT THE SOLE DISCRETION OF JCHS”
INFORMATION ABOUT THE PERSON/GROUP HOSTING THE FUNDRAISER:
Name: ____________________________________________________________________________________
Organization (if applicable): _____________________________________________________________________
Address: ___________________________________________________________________________________
City, State, Zip: ______________________________________________________________________________
Phone: ___________________________________________ Fax: _____________________________________
Email address: ______________________________________________________________________________
If under 18... Age: _________ Parent/Guardian Name: ________________________________________________
INFORMATION ABOUT THE FUNDRAISER:
Title of Fundraiser: ___________________________________________________________________________
Event Date & Time: ___________________________________________________________________________
Event Location: ______________________________________________________________________________
Brief details, description and explanation of benefits to HSNWMT: _________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Does this event require JCHS volunteers? q No q Yes.....How many: ___________________________________
Does this event include an opportunity to showcase adoption center animals? ________________________________
Will you provide printed flyers and/or posters for this event? _____________________________________________
How do you plan to advertise/promote this event? ____________________________________________________
__________________________________________________________________________________________

3. THIRD-PARTY REQUIREMENTS:
We ask please that you abide by the following guidelines when hosting a third party fundraiser for the JCHS.
Please use our legal name, the Jackson County Humane Society, in all advertising and promotion. Where applicable,
please include our street address, phone, and website. Upon request, our logo can be made available for use in print
advertising.
Fundraisers must state the agreed upon portion of proceeds which will be donated to the Jackson County Humane
Society in all advertising, promotions and in all correspondence with donors, sponsors, and participants. The “portion
of proceeds” that will be donated to JCHS may be stated as a “specified” percentage of proceeds or a fixed amount
per sale/transaction.
Please select your choices and fill in the blank with your commitment:
Before expenses (GROSS) _______________________ (or) After expenses (NET) _______________________
Percentage of Proceeds: _____________________ (or) Fixed amount per sale/transaction: ___________________
Funds raised on behalf of the Jackson County Humane Society must be submitted within four weeks after the end of
the event.
Fundraisers must comply with all city, county, state and/or municipal charitable solicitation statutes and/or ordinances
applicable to the fundraiser.
AGREEMENT:
I have read the above information and I agree to abide by these guidelines and I release the Jackson County Humane
Society from any and all liability involving damages or injury that may result or occur as part of this fundraising effort.
______________________________________________________________ ____________________
Signature of Fundraiser Date
FOR MINORS UNDER THE AGE OF 18, PLEASE HAvE YOUR PARENT OR GUARDIAN SIGN BELOW.
I have read the above information and I allow my minor child to host this fundraising event and I agree to abide by these
guidelines and I release the Jackson County Humane Society from any and all liability involving damages or injury that
may result or occur as a part of this fundraising effort and I take full responsibility for my minor child and his/her actions.
______________________________________________________________ ____________________
Signature of Fundraiser Date
The Jackson County Humane Society gives permission to the above to host listed fundraising event on behalf of the
Jackson County Humane Society persuant of this contract.
______________________________________________________________ ____________________
Signature of Jackson County Humane Society Rep Date