K9 Retirement Assistance Application
**Please Read: This form is to be completed prior to any medical assistant request unless an emergency incident occurred. We do not reimburse anyone for medical bills, food, etc. This form is to be filed out by the handler / owner of the retired K9 with supporting documents. If the K9 is accepted into the program of being assisted, we will contact you.
Have you applied for K9 retirement assistance through another organization?
*
Yes
No
If "Yes," which one(s)?
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Department Where K9 Served
*
Retirement Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
K9 Name
*
K9 Age
*
K9 Years of Service
*
Male or Female
*
Male
Female
Photo of K9
*
Browse Files
Cancel
of
Proof of K9 Service
*
Browse Files
Letter from agency or other documentation stating the K9 worked for specific department for specified years.
Cancel
of
Type of Assistance Requested. Please be as specific as possible with brands of food, vet bills, etc. Upload any supporting documents.
*
Assistance Supporting Documents
Browse Files
Cancel
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.
Submit
Should be Empty: