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Fairy DogParents

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Online Application

Step 1: Application for Assistance

Thank you for contacting Fairy Dogparents. Please answer the questions truthfully; all information given is kept strictly confidential. Any false information may result in disapproval of the application and assistance will be denied.

To be considered for assistance, you must:

  1. be the pet's owner;
  2. be 18 years or older;
  3. have a picture ID with your current address;
  4. agree to fill out a new application if you move, or the number of pets in your household changes and for receiving assistance after the first 6 months;
  5. understand the food provided is donated and may not be your current brand, which can upset your pet's stomach;
  6. agree not to hold Fairy Dogparents legally liable in the unfortunate event the recipient's pet(s) become ill or the food upsets the pet's stomach;
  7. agree not to resell the pet food received from Fairy Dogparents;
  8. agree you do not breed any of your pets for profit or sport;
  9. understand Fairy Dogparents has the right to deny your application.
  10. understand Fairy Dogparents provides temporary assistance and I need approval for each additional service my dog received. I will be required to pay a minimum of 15% of the total cost of my dogs care, to reapply after the first 6 months of receiving assistance and that there is an annual $800 maximum for acute/chronic care and a $300 maximum for general wellness needs per family.
By typing your initials below, you acknowledge that you are considering surrendering your dog to a shelter and understand/agree to the above.
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Step 2: Personal Information
First Name
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Last Name
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Address 1
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Address 2
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City
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State
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Zip
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Day Phone
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Alternate Phone
(i.e. cell, evening phone)
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Email Address
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Are you a Massachusetts resident?
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I understand due to the limitations of fairy DogParents 501c3 application that if I am not a resident of MA I will not be eligible for assistance.
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How did you hear about us?





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(include name of Vet, Rescue League, or Shelter)
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Have you received assistance from us before?
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If so, when?
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Do you receive assistance from any government assistance programs?
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If yes, please check which programs you are currently receiving.




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If other, please specify:
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Have you applied to Care Credit through your vet? Invalid Input
Were you approved? Invalid Input
If so for how much? Invalid Input
What is your household monthly income? $ Invalid Input
(proof of income is required)
Before taxes/after taxes? Invalid Input
Do you receive any additional income such as alimony, child support or other: Invalid Input
What alternative funds do you have access to?




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Rent/Mortgage: $ Invalid Input
Car/Transportation: $ Invalid Input
Utilities: $ Invalid Input
Groceries: $ Invalid Input
Other: $ Invalid Input
Please describe your personal financial situation in more detail:
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Step 3: About Your Dog
Dog 1:
Dog's Name
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Age
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Breed
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Sex
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Weight
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Spayed/Neutered
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If no, why not?
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Length of ownership
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Dog 2:
Dog's Name
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Age
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Breed
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Sex
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Weight
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Spayed/Neutered
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If no, why not?
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Length of ownership
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How did you acquire your dog(s)?




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Are any of the dog(s) above current with his/her vaccinations?
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Check all that applies:







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Are any of the dog(s) above on heartworm prevention?
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Are any of the dog(s) above on flea and tick prevention?
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If any of the dog(s) above are not spayed/neutered, do you agree to have your dog(s) spayed/neutered?
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Are any of the dog(s) above registered with your city/town?
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Are any of the dog(s) listed above used for breeding?
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Are any of the dog(s) listed above used for sport?
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Step 4: About Your Dog Continue
Type of assistance requested:




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If you are asking for food assistance, please check off type of food needed:




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Does your dog(s) have allergies or require special food?
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Type of food:
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How much do you feed your dog(s) per day?
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Veterinarian Name
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Address
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Telephone
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What is your veterinarian's recommendation, prognosis and timeframe for treatment?
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What is the cost estimate for treatment?
$
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How much money can you put towards your dog's treatment?
$
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DogParents are required to pay a minimum of 15 percent of the total bill. Fairy DogParents assistance is temporary and limited in time and money.
Does your dog have any other chronic conditions or medical issues?
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If so what are they?
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How long (in days/weeks/months) do you anticipate needing temporary assistance from Fairy DogParents?
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Step 5: Final Release
Please upload a photo of your dog(s) to be used for promotional and fundraising materials if your application is approved. By uploading you agree to relinquish all rights for monetary gain and compensation. Accepted file types are jpg and gif. If you are unable to upload a photo of your dog at this time please email a photo to fairydogparents@live.com. Alternatively we may request a hard copy or photo text message.
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Do you give permission to Fairy DogParents to contact your current or former veterinarian?
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Do you give permission to Fairy DogParents to contact your employer or SSDI/government office to confirm your income? Invalid Input

By completing this form you agree that all information on this form is accurate and will provide requested financial documentation. Additional required documentation may include W-2, foreclosure notice, proof of disability or similar documentation. No money will be issued directly to the recipient; all payments will be made directly to the vendor or medical provider.

Fairy Dogparents is a nonprofit charity organization that provides financial assistance to dogs in need of food, medical needs and general wellness. Completion of this application does not guarantee you will receive assistance. Your application will be reviewed and responded to in order it was received. All monies go directly to provider not recipient of services.

*We require all recipients to undergo spay/neuter surgery to receive services*
Final Applicant Signature
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Type what you see
Type what you see
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© 2009-2013 Fairy DogParents Inc. is a 501c3 nonprofit organization.
All Rights Reserved.