Helping Paws Help Request "*" indicates required fields ​Tell Us About YourselfYour Name* First Last Age* 0 to 17 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or more Ethnicity* White Asian American Indian Black or African American Middle Eastern or North African Hispanic Latino or Spanish origin Native Hawaiian or Other Pacific Islander Other Gender* Female Male Transgender Prefer not to say Marital Status* Married Single Divorced Widowed Household Income* $0 to $24,999 $25,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 $100,000 to $149,999 $150,000 or more Education* Some High School High School Bachelor’s Degree Master’s Degree Ph.D. or higher Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCĂ´te d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRĂ©unionSaint BarthĂ©lemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTĂĽrkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweĂ…land Islands Country Primary Phone*Email* Active Duty or Veteran & list your Rank (note if retired)*Military Branch & Base*How did you hear about us (if it's a veterinary clinic, specify which one)?*Please provide a detailed description of what's wrong with your pet and what your concerns are*Explain why you are unable to cover the costs for your pet.*Tell us about your military service (i.e. years served, any deployments or achievements):*​Tell Us About Your PetPet's Name*Age*Breed*Pet's Sex* Male Female Weight*Are you able to pledge a recurring donation each month to Helping Paws? If so, how much?*Click here to make your pledgeI declare that I have exhausted all alternative options to me for financial assistance and I agree to (initial next to agreed upon term):* I declare and agree I agree to reimburse Helping Paws for any funds received upon a change in my financial circumstances.* I agree I agree to fill out a testimonial after treatment in order to receive a grant* I agree I authorize Helping Paws to use my and/or my pet’s photograph, video and any information relating to his or her procedure and outcome. This is required for fundraising purposes. Please notify us if you are unable to agree to this.* I authorize Upload a photo of you/your family, and your pet in need (if possible, please include one of you in uniform with him/her)* Drop files here or Select files Max. file size: 128 MB. Upload a current photo of your pet* Drop files here or Select files Max. file size: 128 MB. I hereby contest that:I do not own or operate any form of for-profit breeding or pet shop.* I do not own or operate any form of for-profit breeding or pet shop. I understand that these funds are to be used at a participating Helping Paws veterinary hospital.* I understand that these funds are to be used at a participating Helping Paws veterinary hospital. I understand that Helping Paws is not responsible for the treatment and/or outcome of any veterinary services provided and hereby waive all claims of liability against the Helping Paws charitable fund.* I understand that Helping Paws is not responsible for the treatment and/or outcome of any veterinary services provided and hereby waive all claims of liability against the Helping Paws charitable fund. I understand that Helping Paws reserves the right to deny a request for financial assistance to anyone for any reason.* I understand that Helping Paws reserves the right to deny a request for financial assistance to anyone for any reason. I declare, under perjury, that the foregoing is true and correct to the best of my knowledge.* I declare, under perjury, that the foregoing is true and correct to the best of my knowledge. Upon completion, all adults in the house will need to apply for Care Credit and send the response to us at info@helpingpawssandiego.org. Once you hit submit, read the confirmation page for instructions and check your spam file if you don’t receive an email from us.CAPTCHA Δ
