Your First Name
*
Your Last Name
*
Street Address or PO Box
City, State, Zip
Email
Phone
*
How did you hear about our organization?
Basic Household Information
How many children live in your household?
*
0
1
2
3
4
5+
Please tell us about the pet that needs our help. If there is more than one pet, please note that in the comments section and choose one to describe below.
Name of Pet
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Species
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Cat
Dog
Other
Species
Age
*
Sex
*
Female
Male
Other
Sex
If Outdoor, Both, or Other, please describe pet's containment and housing
We ask where the pet is housed because if surgery is necessary, and for spay/neuter, there is usually a requirement for animals to be kept quiet and contained. We must know that you are prepared for this possibility, or that you will work with us for arrangements to be made for this to be accomplished.
If yes, which clinic?
Please explain the situation:
*
Please provide any other information from the veterinarian that would be helpful to us:
Do you have any other comments regarding your situation?
If yes, please explain:
Please explain your financial hardship and tell us why you have reached out to us. The more information we have about exactly what you are asking assistance for, the better we will be able to help you.
*
By entering my name below and submitting this form, I certify that I am agreeing to these requirements and that the answers on this application form are true and correct to the best of my knowledge. I agree to release Advocates for Animals in Jackson County, Inc. and its service providers (veterinarians, trainers, and fosters) from liability should the veterinary care, foster care, or behavioral training rendered prove unsuccessful or the animal becomes ill or injured while in our care.
Type your name below:
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Submit
If you are human, leave this field blank.