Supply or Financial Assistance Application with Happy Feet Pet Rescue

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Introduction & Review

How many animals do you have that need assistance?

1-3 Animals4-8 Animals9-15 Animals16+ Animals

Please list the name of each animal, species type (dog or cat), and ages

Medical Review

Do any of your animals have infections, open wounds, or are showing any other symptoms that might need a vet visit?

YesNo

Are your pets up to date on vaccinations?

YesNo

Are all of your pets spayed or neutered?

YesNo

How can we help?

Please note, we have a limited budget for assistance with medical events. Our funds are primarily intended to assist with spay and neuter, vacciations, or minor medical assistance. We are unable to assist with major medical problems such as intestinal blockages, broken bones, or etc.

Please check which items would help you the most?

Pet food A vet visit for a medical concernCrate, carrier, or other supplies

Any other information you would like to share? If your pet needs a vet visit, please use this space to clearly explain the symptoms your pet is experiencing.

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older. Please note that some organizations have higher age requirements and may require applicants to be 18 or 21 years of age or older. Be sure to review the specific instructions and eligibility requirements for each application carefully before applying.

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