Medical Grant Application Form for K9 Sentinels of Hope

Medical Grant Application Form for K9 Sentinels of Hope

Please provide detailed information about the grant request for retired police & military K9s.
Applicant Full Name

First NameLast Name
Applicant Email Address
example@example.com
Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to K9
K9 Name
K9 Age
K9 Breed
K9 Gender
K9 Service Branch
Type of Work
Years of Service
Reason for Retirement
Reason for Retirement details
Summary of K9's Service History
Describe the Medical Need
Requested Grant Amount (USD)
Breakdown of Estimated Medical Costs
Veterinarian Name or Clinic
Veterinarian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Veterinarian Email Address
example@example.com
Upload Supporting Documents (e.g., medical records, invoices, photos)

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Consent to use application materials
By checking this box and submitting my application of my retired Police K-9/Military Working Dog, I hereby give my consent to K9 Sentinels of Hope (K9SOH), and its subsidiaries, defined as affiliates, sales representatives, agents, consultants, contractors, advertising, marketing and promotional agencies, merchandising partners, vendors; and each of their respective officers, directors, shareholders, agents, representatives and employees; and each of their respective successors, representatives, and anyone authorized by any of them, to use, publish, adapt, edit, modify and/or create derivative works of my program application materials including, without limitation, my name, photographs submitted by me and likeness, my dog's name, their images submitted by me and likeness, city, state, biographical information, statements, and other information and/or materials provided in my program application or in any form of communication hereafter to K9SOH or its subsidiaries and any derivations thereof, throughout the world in perpetuity, for any lawful purpose, including programming, advertising, commerce, trade, promotional, publicity and/or for the creation, sale, distribution, advertising and related purposes of merchandise, and/or other purpose in all and any media, now or hereafter known, worldwide and on the internet or social media, and without additional compensation or consideration to me, or my subsidiaries, and without notification, and in connection therewith.* Please complete this required field.
Communications consent
K9 Sentinels of Hope (K9SOH) is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below: I agree to receive communications from K9 Sentinels of Hope (K9SOH).
By checking this box I certify that all information submitted by me and about my retired Police K9/MWD is true and accurate to the best of my knowledge, and that I am the owner of, or have the right to provide medical care, release, all photographs, images, and documents submitted to K9 Sentinels of Hope (K9SOH). I understand that should it be determined that I have submitted any false or incorrect information that my participation in the program can be terminated for that reason, or any other valid reason, by the Board of Directors at any time.
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