Please check before continuing. *

Applicant Information

Please note: you MUST live in Yamhill County to be eligible for Angel Fund Veterinary Financial Assistance. *
Are you currently homeless? *

Applicant Financial Information

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Do you have any dependents?
Please check which, if any, of the following forms of government assistance are you currently receiving? *
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Are you experiencing a recent financial hardship that we should know about?

Pet Information

Pet's Species
Pet's Sex *
Is your pet spayed or neutered? *
If no, would you be willing to get them spayed/neutered? This is an Angel Fund Requirement. *
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Pet's Medical Information

Additional Information

One of the ways that we can help people and pets in need, is by telling our donors stories about the pets we have helped. We would like your permission to use your (and your pet’s) story to raise funds for Homeward Bound Pets and Angel Fund. Your answer to this question WILL NOT affect our decision about your application.

Can we use your information in our fundraising endeavors? *
If yes, please check what information about you and your pet you would be comfortable with us using (please check all that apply)

By typing my name below and submitting this application, I certify that the information I provided is true and correct to the best of my knowledge. I also agree to the conditions for receiving assistance from Angel Fund and requirements for using Angel Fund that were described prior to the application.

Please be patient after submitting - it may take a moment to upload any files you are including.

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