FKF Application for Assistance
Please complete the following application to be considered for veterinarian assistance from Fur Kids Foundation. Failure to answer all of the questions will result in an automatic denial of the application. Files should be sent to Fur Kids Foundation only. Please do not send your files through the vet's office. Note: If the applicant is under the age of 18, or has a designated signature authority, the Applicant’s Personal Representative may submit this form.

If you have questions, please contact the Fur Kids Foundation at 307.363.1131, furkidsfoundation@gmail.com, or PO Box 7074, Gillette, WY 82717. A hard copy of the application is available upon request.

Please Note: The Foundation is designed to provide assistance for families with pets in need. There is no restriction regarding pet species. The Foundation does not pay for routine vet visits, vaccinations, or optional surgeries such as de-clawing, spaying or neutering. It is important to note that each applicant is reviewed on a case-by-case basis by the Foundation's Case Managers, and not all applicants meet the Foundation's guidelines. The Case Managers review each application, contact applicants and veterinarians. They typical process takes from one to three business days, depending upon requirements of treatment, and, most importantly, the cooperation of the pet owner and veterinarian. Fur Kids Foundation does not guarantee approval of applications. The Foundation neither guarantees nor is responsible to pay full amounts of veterinary care. The Foundation pays the veterinarian office directly; it does not reimburse the pet owner. Applicants must make payment arrangements with Animal Medical Center of Wyoming, Red Hills Veterinary Hospital and Thunder Basin Veterinary Clinic PC for any remaining balance that the Foundation does not cover.

Before you apply, ALL of the following must be true:
1) You are the animal's primary caretaker and owner, and the person who pays for the animal's medical care.

2) You are working with one of the veterinary clinics in Campbell County, Wyoming that the Foundation does business with.

3) You gave your veterinarian permission to speak to Fur Kids Foundation (FKF) about your pet.

4) You have these documents on your computer, saved as pdf filed or jpeg, and ready to upload in the application as required by Fur Kids Foundation:
a. Proof of ID

b. Most recent proof of income for all adults (over the age of 18) in the house: payroll stub, unemployment stub, child support statement, disability stub, etc. Please note: You must attach all to receive financial support from Fur Kids Foundation.

c. 1040 from most recently filed tax return if the case exceeds $500 and more; or if the Foundation helps the applicant with an online fundraiser (criteria outlined in Fur Kids Foundation Terms of Assistance). Fur Kids Foundation Case Managers will request this information when needed.

You must get this information to your FKF Case Manager within 24 hours of sending in an application. If this information is not received, your application will be denied.

5) You are willing to volunteer for FKF.

I have read and verify that the information outlined above is true, and I agree to the terms and conditions: *
How did you hear about Fur Kids Foundation: Please select all that apply.
Applicant's Information
First Name *
Your answer
Last Name *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Email Address *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Applicant's age *
Note: If the applicant is under the age of 18, or has a designated signature authority, the Applicant’s Personal Representative may submit this form.
Your answer
Name and age of spouse or live-in boy/girlfriend. *
If you fill in a name, explain his/her relationship to you and to your pet. If none, type "none."
Your answer
Names and ages of other adults (persons over the age of 18) living in your home. *
If none, type "none." If adults in the home, type their NAME, AGE, and RELATIONSHIP to you, for each.
Your answer
Who pays household expenses? *
Required
Are you currently working? *
Please list employer/s or describe why you are currently unemployed *
Your answer
Please list your occupation at current or most recent job *
Your answer
Is your spouse or live-in boy/girlfriend employed? *
If none, please select none.
Please list your spouse or live-in boy/girlfriend's employer/s or describe why you are currently unemployed. *
If you don't have a spouse or live-in boy/girl friend, please type "none".
Your answer
Please list your spouse or live-in boy/girlfriend's occupation at current or most recent job? *
If none, please type "none".
Your answer
Do you have any dependents on last year’s tax return? *
If yes, please include names and ages of all dependents. If you don't have a any dependents, please type "none".
Your answer
What is the monthly Income received from ALL adult household members listed above. *
This includes payroll, Social Security (SSI), Disability, Child Support, Unemployment, and any other form of financial support your household receives.
Your answer
Any change in income/expenses from last year?
If yes, please explain. *
Type "none" if there was no change.
Your answer
Do you own your home? *
What is your monthly rent/mortgage? *
Your answer
Do you receive any social services? *
If yes, select which social services you receive. If you don't receive social services, select none.
Required
What is your current financial situation? *
Please explain why you are in a financial situation where you need FKF's help. For example: Why are you asking the Fur Kids Foundation for assistance? Have you lost your job? Are you on disability or is your income limited? Is your household dependent upon one income? Are you just in a tight spot at the moment? Please be descriptive.
Your answer
Veterinarian's Information
Name of Veterinary Clinic *
Required
Name of family vet *
Your answer
Do you give Fur Kids Foundation Case Managers permission to speak with the clinic and the veterinarian? *
Account Holder's Name
If the name on this application is not the same as the name on the account at the vet clinic for the pet the Foundation is helping, please list it here.
Your answer
Do you have pet insurance? *
Pet's Information
Pet's Name *
Your answer
Pet's Breed *
Your answer
Pet's age *
Your answer
Pet's sex *
Your answer
Is your pet up to date with their vaccinations? *
If your pet is not up to date with their vaccinations, why not? *
If your pet is spayed or neutered, please enter none.
Your answer
Is your pet spayed or neutered? *
If your pet is not spayed or neutered, why not? *
If your pet is spayed or neutered, please enter none.
Your answer
Please describe your pet's injury or illness: *
Please be descriptive.
Your answer
Has your pet had previous health issues? *
Your answer
Describe your relationship with your pet. *
Your answer
Please list the names, breeds, and ages of other pets in your home. *
Your answer
Is there anything else you would like to tell Fur Kids Foundation?
Your answer
Documents
You must get the following information to your FKF Case Manager within 24 hours of sending in an application. If this information is not received, your application will be denied.

Please send scanned documents or photos of the documents outlined below to Fur Kids Foundation by one of the following ways:

1. Email: Attach scanned or pictures of the documents to an email and send it to applicationsfkf@gmail.com.

2. Text or Multimedia Messaging Service (MMS): In your phone's text screen, input applicationsfkf@gmail.com in the "to" section instead of a phone number. From there, you can send pictures of the documents to the Foundation via text. You may also text pictures of the documents to a case manager when one has been assigned to you.

Please note: Files should be sent to Fur Kids Foundation only. Please do not send your files through the vet's office.

1. Please upload a copy of your photo ID. This is required for all cases. Please DO NOT send Fur Kids Foundation your Social Security card. We only ask for one proof of ID, and we want it to be a photo ID.

2. Please upload a copy of your most recent proof of income:
- payroll stub
- unemployment stub
- child support statement
- disability stub, etc.

This is required for all cases.

3. Please upload the 1040 from your most recently filed tax return if the case exceeds $500 and more; or if the Foundation helps the applicant with an online fundraiser (criteria outlined in Fur Kids Foundation Terms of Assistance). Fur Kids Foundation Case Managers will request this information when needed.

Please note: You must attach all proof of income documentation that you receive in order to receive financial support from Fur Kids Foundation. Once your case is completed, your photo ID, proof of income information and tax documentation is is deleted from our storage and all copies are shredded.

Photo of your Pet
When you submit this application, you grant FKF your permission to tell your pet's story. Please know that the pet owner's names are removed from all stories, but we do need a healthy photo of the pet (cell phone pictures are fine); we don't need a picture of your injured pet. We post these stories so people can see the good work that we do. You can view examples on www.furkidsfoundation.org.

Again, please send scanned documents or photos of the documents outlined below to Fur Kids Foundation by one of the following ways:

1. Email: Attach scanned or pictures of the documents to an email and send it to applicationsfkf@gmail.com.

2. Text or Multimedia Messaging Service (MMS): In your phone's text screen, input applicationsfkf@gmail.com in the "to" section instead of a phone number. From there, you can send pictures of the documents to the Foundation via text. You may also text pictures of the documents to a case manager when one has been assigned to you.

Please send files to Fur Kids Foundation only. Please do not send your files through the vet's office.

I agree to email the required documentation to my Case Manager. *
You must send a copy of your Photo ID and all proof of income documentation that you receive in order to receive financial support from Fur Kids Foundation within 24 hours of submitting an application. If this information is not received, your application will be denied.
Fur Kids Foundation Terms of Assistance
1. * For all cases, Fur Kids Foundation requires a copy of the applicant’s photo ID and most recent proof of income (payroll stub, unemployment stub, child support statement, disability stub, etc.)

2.** For assistance greater than $500 Fur Kids Foundation will require previous year's 1040 and previous month's payroll stub, SSI, child support, and unemployment.

3. ***If expenses are greater than $1,500 Fur Kids Foundation will review the possibility of a fundraising campaign such as Go Fund Me, Fundraiser, etc. For these cases an additional agreement will need to be signed acknowledging you will assist with fundraising to cover your case costs, and the agreement will be given to you to complete at that time.

4. ****When treatment is NOT available from ANY of the veterinary clinics in Campbell County, Wyoming and treatment is required out of state, Fur Kids Foundation will review the possibility of a fundraising campaign such as Go Fund Me, Fundrazr, etc. For special cases an additional agreement will need to be signed acknowledging you will assist with fundraising to cover your case costs, and the agreement will be given to you to complete at that time.

5. You grant FKF your permission to print or post all photos/text that you send us or that you post on the FKF Facebook or Twitter pages, to promote FKF.

6. If FKF arranges a media story (TV, newspaper, etc.) about your pet and the assistance you received from FKF, you may be asked to be available for interviews and photos with the producer, journalist, or editor.

7. FKF is not in any way responsible for the results of your pet's treatment, the quality of your pet's medical treatment, or any treatment side effects.

8. FKF does not cover the cost of routine visits, dental cleanings, routine vaccinations, spays or neuters, debarking, declawing, or any cosmetic procedures.

9. FKF does not cover the cost of burials or cremation.

10. FKF does not cover 100% of the medical expense. Your dedicated Case Manager will work closely with you and your vet clinic to discuss the amount, if approved. If approved, funds are paid directly to Animal Medical Center of Wyoming, Red Hills Veterinary Hospital, or Thunder Basin Veterinary Clinic PC.

11. FKF does not cover past due accounts.

12. You agree to make payment arrangements, when applicable, to the vet clinics for any remaining balance for your pet's treatment.

13. You will be denied for future assistance if you do not follow through with payment arrangements with your veterinary clinic, stop payments on payment arrangements, or surrender your pet to a shelter or rescue after FKF has assisted with treatment funds.

14. If there is less than a 30% survival rate and/or veterinarian recommends euthanasia as the best interest of the pet, FKF will not cover additional fees if further treatment is pursued.

15. FKF does not guarantee, nor is responsible for approving your application.

16. FKF has the right to refuse assistance to anyone.

17. FKF pays the vet clinic directly; we do not reimburse the pet owner.

I have read and agree to Fur Kids Foundation’s Terms of Assistance. *
Confirmation
By submitting this Application for Assistance, you acknowledge that the information you have provided is accurate and permit the Fur Kids Foundation to speak with your vet about the application.

As stated in the application, the following information MUST be provided in order to process your application. Your Case Manager will be in contact with you once all of the below information is received.
• Most recent proof of income for all adults over the age of 18 in the home
• Proof of identification
• Picture of pet needing assistance

If you do not have access to a scanner you may take a picture of the needed documents and text or email them to this email, applicationsfkf@gmail.com. For text messages, insert the email address in the field you would input a phone number.

If you believe that your pet's life is in immediate danger, you should apply, but seek immediate assistance from a licensed veterinarian. We will consider assisting in cases where treatment has already occurred if the pet's life was at risk.

If you have questions that need answered immediately, or have not heard back from your Case Manager 24 hours after applying, please contact the Fur Kids Foundation at 307.363.1131.

If you have questions, please contact the Fur Kids Foundation at 307.363.1131, furkidsfoundation@gmail.com, or PO Box 7074, Gillette, WY 82717. Learn more about Fur Kids Foundation at www.furkidsfoundation.org.

Warm regards,
FKF Applications Committee

Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.