Helping Paw Fund Application
Before completing the application, please review the guidelines at http://carecentercu.org/wp-content/uploads/2016/10/CARE-Center-Helping-Paw-Fund-Application.pdf. At this time, we can only provide support to individuals and families living in East Central Illinois. NOTE: APPROVAL IS REQUIRED BEFORE SERVICES ARE PROVIDED.
First Name *
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Last Name *
Your answer
Street Address *
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City *
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State *
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Zip Code *
Your answer
Phone Number *
Your answer
Alternate Phone Number
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E-mail Address *
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Number of Adults in Household *
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Number of Children in Household *
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Number of Cats in Household *
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Number of Dogs in Household *
Your answer
Number of Cats/Dogs in Household that are Spayed/Neutered *
Your answer
Number of Cats/Dogs in Household that are Vaccinated *
Your answer
How did you hear about the CARE Center's Helping Paw Fund? *
Your answer
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