Lynette Dryden Memorial Animal Care Fund Application Form

Animal Friends of the Valleys

33751 Mission Trail, Wildomar C.A 92595

Tel: 951-674-0618 X219 Fax: 951-471-8285

Lynette Dryden Memorial

Animal Care Fund

The Lynette Dryden Memorial Animal Care Fund was established in June 2013 by Animal Friends of the Valleys for the care and treatment of animals for low-income individuals in the cities of Canyon Lake, Lake Elsinore, Menifee, Murrieta, Temecula, and Wildomar.

Client Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone

Cell Phone

Email

example@example.com

Current Monthly Income

# of people in household

Sources of Income (check all that apply)

Pension Employment Social Security SSI Unemployment Other

List your total number of pets:

Cats

Dogs

Other (Please Specify)

Are your dogs currently licensed?

Are all your animals altered?

Which pet(s) currently need veterinary care?(Species/Name of Pet/Sex/Age/Breed/Care Needed)

The information provided above is accurate. I understand that the Lynette Dryden Animal Care Fund is limited and I may not receive assistance, even if I qualify if there is no funding available. Final approval is at the discretion of Animal Friends of the Valleys.

Signature:

Clear

Date

02/02/2021