Application for Funds : For the Love of Dogs

Application for Funds
For the Love of Dogs™ was established to assist rescue groups (or individuals who rescue) with veterinary bills in special needs cases. Please submit the information below regarding your group and the specifics of the dog for which you need funds. Please note For the Love of Dogs™ was created to help pay the vet bills of dogs rescued by rescue groups that are going to be placed in new homes. We pay directly to the veterinarian for bills submitted by the rescue groups for these dogs, we do not distribute funds directly to rescue groups or private individuals.
Rescue Group Information * Required Field
Are you part of a rescue group or an individual performing rescue	Rescue Group Individual
Name of Group or Individual *
Contact Name *
Email Address *
Contact Phone Number *
Web Site
Breeds that you rescue [if breed specific] *
# of dogs rescued, annually *
$ spent on veterinary bills, annually *
Veterinarian Information
Name of Clinic *
Name of Vet *
Phone Number *
Fax Number
Address *
City, State, Zip *
Does your vet give you a discount for rescues?	Yes No
Describe the Need for Funds
Dog's Name *
Dog's Age *
Please describe the dog's situation and injuries. *
Please upload a photo of the dog for our web site.

Application for Funds