Financial Assistance Request

Application for Financial Assistance

This form is intended to help us understand your circumstances and assess your request for financial assistance. Please provide as much relevant information as possible. All requests will take into account the needs and welfare of the dog and any exceptional or extenuating circumstances.

Confidentiality

The information provided in this application will be treated as confidential and handled sensitively, in accordance with GDPR. Information will only be shared with relevant individuals where necessary for the purpose of assessing and administering your request for financial assistance.

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Dog's name

How long have you owned or cared for the dog?

Do you have sole responsibility for the dog?

What type of financial assistance are you requesting?

Please provide details of the support required, for example veterinary fees, specialist diet, dog walking or other essential care. Please provide estimated costs if you have them

For what period of time do you require this assistance?

Please explain why you are requesting financial assistance

Please provide details of your current circumstances and explain why you are unable to meet these costs / care at this time. This may include unexpected changes in your situation, exceptional / extenuating circumstances or any other factors that have affected your ability to provide or fund the care your dog requires.

Please provide any other information that you feel may be relevant to your application

Declaration

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I confirm that, to the best of my knowledge, the information provided in this application is accurate and complete. I understand that providing this information does not guarantee that financial assistance will be awarded and that any support offered will be subject to assessment and availability of funds.

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