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Please complete the following information regarding you and your pet:
Tell Us About Yourself
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Primary Phone
*
Cell Phone
*
Email
*
Active Duty or Veteran
*
Military Branch
*
Rank (Please note if retired)
*
Base
*
How did you hear about the HP Program?
*
Please provide a detailed description of what's wrong with your pet and what your concerns are
*
Explain why you are unable to cover the costs for your pet at this time
*
Tell us about your military service (i.e. years served, any deployments or achievements):
*
Tell Us About Your Pet
Pet's Name
*
Age
*
Breed
*
Color
*
Pet's Sex
*
Male
Female
Weight
*
Are you able to pledge a recurring donation each month to Helping Paws? If so, how much?
*
Click here to make your pledge
I declare that I have exhausted all alternative options to me for financial assistance and I agree to (initial next to agreed upon term):
I agree to reimburse Helping Paws for any funds received upon a change in my financial circumstances.
*
I agree to volunteer for Helping Paws’ special events and fundraisers
*
I authorize Helping Paws to use my and/or my pet’s photograph, video and any information relating to his or her procedure and outcome. This is required for fundraising purposes. Please notify us if you are unable to agree to this.
*
Which hospital location do you prefer to visit: Carlsbad, Escondido or Vista?
*
Carlsbad
Escondido
Vista
I hereby contest that:
- I do not own or operate any form of for-profit breeding or pet shop.
- I understand that these funds are to be used at a participating Helping Paws veterinary hospital.
- I understand that Helping Paws is not responsible for the treatment and/or outcome of any veterinary services provided and hereby waive all claims of liability against the Helping Paws charitable fund.
- I understand that Helping Paws reserves the right to deny a request for financial assistance to anyone for any reason.
- I declare, under perjury, that the foregoing is true and correct to the best of my knowledge.
Full Name as Signature
*
Date
*
*To expedite your need, we encourage you to apply for Care Credit and forward their response to us at
info@helpingpawssandiego.org
. Once you hit submit, read the confirmation page for instructions and check your spam file if you don't receive a confirmation email.
Submit
Home
About Us
Our Mission and Vision
Our Founder
Board of Directors
Leadership Team
IRS Forms, Founding Documents & Financials
Apply for Help
Get Involved
Events
How to Help
Our Sponsors
Volunteer
Shop
Our Impact
Videos
Stories
Press
Write a Testimony
Help Agencies
Help Agencies
Contact Us
Contact Us
Become a Participating Hospital
Donate
Support Us