Medical Kit Application
Have you applied for a medical kit through another organization?
*
Yes
No
If "Yes," which one(s)?
Is your agency/supervisor aware you are applying and can accept this as a donation to the agency under your department/city/county policies and procedures?
*
Yes
No
Handler Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Department Name
*
Department Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
K9 Name
*
K9 Breed
*
K9 Age
*
K9 Weight
*
Male or Female
*
Male
Female
K9 Duties
*
Photo of K9
*
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of
By submitting this form, you are aware that GPK9F will possibly contact media outlets for press releases and potentially making social media platform posts to raise awareness.
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