Name *

First Name

Last Name

Phone *

(###)

###

####

May we communicate with you via text messaging? *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I certify I am the owner of this dog *

Yes

No

Has the medical care already been provided? *

Yes

No

Has the care already been paid for? *

Yes

No

Is the medical care needed an emergency? *

Yes

No

Maybe

Would you be willing to have your pet receive care at one of our partner veterinarians? *

Yes

No

Maybe

I have received funding from Operation D.O.G. previously? *

Yes for the same dog

Yes for a different dog

No

Is your dog spayed or neutered? *

Yes

No

If no, are you willing to spay or neuter your dog as a part of the funding received from Operation D.O.G.? (Please note: ODOG will not provide assistance to applicants who are unwilling to spay/neuter their dog) *

Yes

No

Maybe

Already spayed/neutered

If no, are you willing to have your dog vaccinated as part of their care through Operation DOG?

Yes

No

I will send a written estimate of care from my veterinary provider to: *

operationdoonlygood@gmail.com

PO Box 24, Rickreall, OR 97371

I do not have an estimate

I will send proof of income or supplemental documentation demonstrating a need for financial assistance to: *

operationdoonlygood@gmail.com

P.O. Box 24, Rickreall, OR 97371

I do not meet income guidelines

By submitting this application, I attest that I am the legal owner of the dog for who I am comleting this application and I have answered the questions in this document honestly and to the best of my knowledge. I agree to allow Operation D.O.G. to use my story and photos of my dog on their website, for social media, or other marketing materials. I will not hold Operation D.O.G. liable for any medical outcomes for my dog. I understand that Operation D.O.G. will provide payment directly to the medical provider and may determine to not provide funding at any time due to any reason. I understand that funding is dependent on my agreement to spay/neuter my dog unless they are already spayed/neutered:: *

I agree

I do not agree