Request for Financial Assistance | Senior Dog Haven & Hospice

Your Information

Your Name

Address

City

State

Zip Code

Phone Number

Email

Dog Information

Name of Pet

Description of your pet’s need:

(Please include as many details as possible):

What steps have you taken to try to address your pet’s need?

What else would you like us to know about your situation?

Are you willing to use our rescue’s vet?

Yes

No

Please upload a picture of your dog:

Maximum upload size: 2.1MB

Attestations

In the event we are able to provide financial assistance for your dog’s need, do you consent to us sharing your dog’s photo and story on our social media to fundraise for their vetting needs? Owner’s name and location will be kept anonymous.

Yes, I consent and agree.

In the event we are able to raise money for more than what your dog needs for their vetting, do you understand these funds will be used to help other owner assistance requests?

Yes