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Please complete the following information regarding you and your pet:
Tell Us About Yourself
*
Indicates required field
Name
*
First
Last
Age
*
0 to 17
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or more
Ethnicity
*
White
Asian
American Indian
Black or African American
Middle Eastern or North African
Hispanic Latino or Spanish origin
Native Hawaiian or Other Pacific Islander
Other
Gender
*
Female
Male
Transgender
Prefer not to say
Other
*
Marital Status
*
Married
Single
Divorced
Widowed
Other
*
Household Income
*
$0 to $24,999
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $149,999
$150,000 or more
Education
*
Some High School
High School
Bachelor's Degree
Master's Degree
Ph.D. or higher
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Primary Phone
*
Email
*
Active Duty or Veteran & Rank (note if retired)
*
Military Branch & Base
*
How did you hear about us?
*
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.
*
Tell us about your military service (i.e. years served, any deployments or achievements):
*
Tell Us About Your Pet
Pet's Name
*
Age
*
Breed
*
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 fill out a testimonial after treatment in order to receive a grant
*
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.
*
Upload a photo of you/your family, and your pet in need (if possible, please include one of you in uniform with him/her)
*
Max file size: 20MB
Upload a current photo of your pet (additional photos can be emailed to info@helpingpawssandiego.org)
*
Max file size: 20MB
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
*
*Upon completion, all adults in the house will need to apply for Care Credit and send the 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 an email from us.
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