Apply For Assistance Apply For Our Foundation Dog Program There was an error trying to submit your form. Please try again. Apply to become a harlows heroes foundation team and recieve assistance under our foundation.Please answer the following questions to help us learn more about you and how we can best help you!*** IF YOUR DOG IS HAVING A MEDICAL EMERGENCY – DO NOT FILL THIS OUT – PLEASE CALL / TEXT KRISTA FOR IMMEDIATE ASSISTANCE (860) 857-8298 – Krista Full Name * This field is required. Phone Number * This field is required. Email Address * This field is required. K-9’s Name * This field is required. K-9’s DOB * Please specify their DOB or best guess This field is required. What Agency Did They Work For * This field is required. What City & State Was your Agency Located In * This field is required. Years of Service * Please use the format – YYYY–YYYY. This field is required. What Was Your K-9 Certified In? * Please list everything your K-9 was Certified In This field is required. Who Was Your K-9 Certified Through? * Please specify the certifying agency or organization. This field is required. Current Veterinarian * This field is required. Dog’s Approx Weight * This field is required. Highest Need for Care? * What is your dog’s current need under our care, if any. This field is required. Pre-existing Conditions or Injuries * Please note any pre-existing conditions or injuries, NO injuries or conditions would ever disqualify a K9 from receiving care, this just helps us better understand their needs. This field is required. Food Currently On * This field is required. Is your K-9 Currently Undergoing treatment for Anything? * This field is required. Are you currently receiving care, services, or financial assistance from another nonprofit, foundation, or support program? If yes, please list the organization(s) and the type of assistance provided. * This field is required. Noteable Service Moment * Share a notable moment from your dog’s time in service. We do publish these so only include information that is aloud to be made public. ALL TYPES WELCOME (Bites, Finds, Tracks, Comfort.) People LOVE to know how our dogs helped their community. This field is required. Instagram Handle Best if you have one specific for the K9, but you can share your personal one if you are comfortable. This field is required. What is Your K9’s New Favorite Hobby in Retirement * This field is required. What Are Your K-9’s Favorite Toys * This field is required. What is your K-9’s Favorite Treat * This field is required. Please Upload a Picture of Your K9 * Click to upload or drag and drop This field is required. Submit There was an error trying to submit your form. Please try again.
