DAWGS Welfare Fund Application

DAWGS Welfare Fund Application
Please DO NOT complete this form if you need help for a dog rehomed from DAWGS. Please contact our office directly for assistance.
51 - 53 Main Street, Alford AB33 8PX
T: 01224 208989 | E: info@dawgs.co.uk
Terms and Conditions
1. The DAWGS welfare fund is available to support people in need with the costs of necessary veterinary bills and/or any other assistance that your dog may require.
2. For medical assistance, please consult your vet BEFORE contacting us. A quote for treatment must be included with the application.
3. All requests will be considered by a sub-committee of Trustees and details of their decision will be forwarded as soon as practicable.
4. In order to help as many dogs as possible, any person with a dog in need may only receive one DAWGS Welfare Fund payment per year.
5. DAWGS will contact the nominated vet prior to any offer being made and all payments will be made directly to the nominated vet or supplier if the request is for non-veterinary assistance.
6. A cap of £500 will be placed on all applications. If the request is for a sum greater than this, it will be presented to all Trustees for consideration.
  
  Guidance payment scale:
  
  £1 - £150 Consultations, bloods etc.
  
  £151 - £350 Wound care, claw injuries, poisoning etc.
  
  £351 - £500 Fracture/ breaks, accidents, gastro issues,pyometra, ortho/ specialist treatment etc.
YOUR DETAILS: Name*

First nameLast name
Address

Street address

Street address line 2

CityState / Province

Post code
Telephone*
Email*
DOG'S DETAILS: Name
Breed
Age
Gender

MaleFemale
My dog is unwell, but it is NOT urgent. Please describe illness
My dog is unwell and it is URGENT. Please describe illness
YOUR VETERINARY PRACTICE: Name and address
Telephone
ABOUT YOU: Are you in receipt of any of the following? (Please select all that apply)

Housing Benefit (means tested help with your rent)Council Tax Support/Reduction SchemeUniversal Credit with a housing elementUniversal Credit without a housing elementChild Tax/Working Tax CreditPension CreditIncome SupportJob Seekers AllowanceEmployment and Support Allowance (ESA)Disability Living Allowance/Personal Independence Payment (PIP)State Retired Pensioners who are in households (Council Tax Bands A-D)OtherI do not receive benefits
If OTHER, please provide details
Please supply any other information to support your application
Please provide proof of financial support

Cancelof
Quote for Treatment (per point 2)

Cancelof
Declaration*

I declare that the information contained in this application for Welfare Fund assistance is true and give DAWGS permission to speak to my veterinary practice if necessary.
Consent*

I consent to DAWGS using the information I have provided in order to assist with Welfare Fund activities.
Signature

Clear
Name
Date

DayMonthYear
DAWGS, 51 - 53 Main Street, Alford AB33 8PX | T: 01224 208989 | info@dawgs.co.uk | www.dawgs.co.uk

Dog Action Working Group Scotland (known as DAWGS) is a Scottish Charitable Incorporated Organisation (SCIO) regulated by the Scottish Charity Regulator (OSCR). Scottish Charity number: SC022666
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DAWGS Welfare Fund Application

Terms and Conditions