Owner's Name(Required) First Last Owner’s Phone(Required)Owner’s Email(Required) Pet’s Name(Required) Tell us what type of pet you have(Required)DogCatOther (Please describe below)Specify Other Enter your pet’s breed (if unknown, enter N/A)(Required) Diagnosis(Required) Tell us about your pet and why he/she is meaningful to you (at least 100 words):(Required)Tell us your “Love Story”. What do you love most about your pet? Do they have a favorite toy, quirky personality traits, etc.? (at least 100 words):(Required)Why do you feel your pet should be considered for financial assistance (at least 100 words)?(Required)Photo Requirements: Please upload a minimum of three (3) photos of you and your loved ones with your pet. We are all about the human-animal bond so we want to see you with your furry family member. Photos of pets without humans are accepted as long as there at least three (3) great photos of humans with your pet. Applications may be delayed if this important step is not taken.(Required) I have read and agree to the photo requirements.Upload your favorite photos of your pet enjoying time with you and your loved ones. We want to see the human-animal bond in action! You must supply a minimum of 3 images that include your pet with their loving humans.(Required) Drop files here or Select files Max. file size: 100 MB. At least three (3) photos include my pet with loving humans?(Required) Yes No Let’s make this a win-win for both you and Saving Gracie100% of the funds we use to save the lives of pets comes from your neighbors in the community. It is our sincere desire to serve all qualified applicants. There are many ways in which you can pay the gift you may receive forward so we can sustain the ability to give to other individuals like you, who find themselves confronting the loss of a pet due to financial struggles. We kindly request that you help support one of these no or low cost options should you be granted our assistance. AFTER MY PET’S PROCEDURE, MY COMMITMENT TO SAVING GRACIE WILL BE:(Required) I commit to providing Saving Gracie with a post procedure photo & written testimonial about my experience for Saving Gracie Love Stories. Signing up for a recurring monthly donation of $5 or more Liking Saving Gracie on Facebook and Instagram and sharing posts Doing a birthday fundraiser on Facebook, sharing my story and asking friends and family to support Saving Gracie Asking my employer if they have a donation match program Telling friends and family about how Saving Gracie impacted my life as well as my pet’s health. Other If other please fill out below. How did you find out about Saving Gracie?(Required) Terms and Conditions: I certify under penalty of perjuryI have met all of the qualifications and have exhausted all options to independently finance this procedure for my pet(Required) Agree I am at least 18 years of age and I am the legal owner of the pet named above in this application(Required) Agree I understand I am responsible for paying all of the costs for no or the initial exam and diagnosis. I am also responsible for the cost of any follow up treatment (if applicable).(Required) Agree I have permission to grant use of the photos and/or videos I have provided in this application. I understand that Saving Gracie could potentially use the photos/videos I’ve provided for marketing purposes that can include, but are not limited to the saving-gracie.org website, social media platforms, print materials, advertising, and for other public use as needed.(Required) Agree All funds raised by me for this procedure, whether online or in person will be deducted from the balance due at checkout. Funds received post procedure must be paid back to Saving Gracie via my veterinarian. Fundraising that is not disclosed upon submission of this application will result in a denial of this application.(Required) Agree I release and hold harmless Saving Gracie from any liability or responsibility for the health and well-being of my pet with regard to this procedure. In the unlikely event an issue arises with respect to my pet’s procedure I will direct my concerns to my veterinarian.(Required) Agree I agree to honor the commitment I made above to support Saving Gracie on my own without being prompted by the Saving Gracie team.(Required) Agree Send Gracie’s Gazette, your quarterly email to my inbox!(Required)Yes please!No thanks, maybe later.CAPTCHA
