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Give our mission your support by e-mailing us your comments, tell a friend, donations, volunteer, community support, and tell us and others a story of how we could have help you or someone you know in need if we had, had the donations, your donation will help keep our funds available to those in need. Pleases visit our Buisness Sponsers site area, support them when needing services to thank them for helping.

Help us to... Try Keeping animals in their homes First !

Office Location : 1045 Wooded Acres Drive, Hardy, Va 24101

Your Opinion Counts, Your Donations Help

Office Phone: 580-890-9115 Referral Application

Helping Hooves Paws, & Claws    APPLICATION FOR SERVICE    Referral Request Form

  HHPC-1045 Wooded Acres Drive-Hardy, VA 24101Office: 540-890-9115         Mobil: 540-793-9115 This application may be for request or by referral. If you are not the person in need but are filling out this application because you know of someone in need, please give us what information you may know, and why you feel they qualify for assistance from our organization, indicate at the applications end, your name, relationship, or how you know of this need.Pet ownership is a commitment that a family or person makes, we want to make sure each applicant is physically and financially able to be responsible of pet ownership. Not everyone that owns a pet is always able to provide what they may want to at times for their pet. Our pets share our good times and hard times equally with us. The HHPC recognizes this and wants to help those that may be in need of help at times due to circumstances not of their control.Please complete the following form to tell us about you, your pets, home, and needs.  Let us know why you have applied for services and how you heard about us, to help us, not just help you, but others with your information will help to reaching out in our community to assist those with animal needs.
Name 
Address 
  
Home &/or cell phone 
E-mail 
How you heard about us or who referred you 
Animal breed and type 
Needs 
  
 Additional information you may fell will be helpful for us to serve your needs or the needs of others

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Have you or anyone in your home ever been convicted of any animal related misdemeanor or felony offense that was and can be proved to have been due to circumstances not of your control .

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Have you or anyone in your home ever had to surrender an animal to, or had an animal seized by an animal control officer for a reason of circumstances not of your control.

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Please indicate if yes to either of the above, could have the circumstances been different if you had been able to receive assistance or given a referral of someone that could have assist  you with, help, education, directed you in a means of help, or even given support on the side of an animal in court.

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About my animal and needs, Livestock, pet, or exotic pet (please indicate if herd animal or domesticated)

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Housing or shelter   (please indicate indoors, outdoors, fencing)

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_______________________________________________________________________Current veterinarian_______________________________________________________Last visit, present or past illnesses____________________________________________________________________________

Animal current training as may apply or indicate behavioral problems _______________________________________________________________________

_______________________________________________________________________If this is a new animal for you please indicate your current or previous training abilities or indicate your training or educational needs____________________________________________________________________________________________________ Ithas been averaged a dog may cost the caretaker $300-$500, cat $200-$400, horse $1200 - $2000 per year. What do you estimate your cost. ____________________________________________________Please provide two personal references

Name_______________________________________________ Phone______________

Name_______________________________________________ Phone______________

Employment, Income & Expenses

Present Job _____________________________________________________________

Average annual income____________________________________________________Average annual home expenses_____________________________________________Explain reason for application_______________________________________________

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_______________________________________________________________________Is this an assistance request or loan, indicate type or estimated amount______________     Feed, Medical Care, Housing or Shelter Need, Fencing Need, Other (circle one)

As part of your assistance needs provided by our organization, do you intend on repaying the assistance in payments,   future payments ,   donations,  by   helping others through volunteering to our organization now  or  in the future,  other    (Circle one or explain)  ______________________________________________________________

_____________________________________________________________________Do you agree to an evaluation of the animal’s requested need?     Yes_____    No_____Will you agree to be used or help us as advertisement for donations in pictures, story, or provide a statement of recommendation for our organization?        Yes____      No_____The information provided in this application for assistance to the best of my knowledge is true and correct to the best of my knowledge. If at any time the information provided is found incorrect an update will be provided.The HHPC request your assistance in providing us with an evaluation on how our services may have assisted you and your opinion on areas we may improve on to serve the community better.Please be aware our funding is available through donation and we may not be able to assist each and every individual at the time of need. Your assistance to dentate through the help in volunteering to educate the community of those animals in need of our services will be greatly appreciated.

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Applicant signature or person of referral                          Date of request  

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FOR OFFICE USE ONLY             Assigned File Number     ____________

Received by ______________________________     Date______________

Approval Recommended      Yes____     No____               Funds Available                    Yes_____   No_____            

Program Type / Referral to Service Provider             _________________

Comments____________________________________________________

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Instructions___________________________________________________

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