Off The Chain Application

Off The Chain Application

Ashe Humane Society's Fence-building Program to help families install safe, secure enclosures for their dog to enjoy greater freedom
This application is for pet owners of Ashe County NC. Applicants must own the property that the fence is to be erected on or must have written approval by the property owner to have the fence erected. Dogs must be spayed or neutered and up to date on vaccinations in order for this application to be considered. Submission of an application does not guarantee approval. Assistance is based on eligibility, available funding, volunteer availability and the needs of the dog.
Your Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your physical home address; no P.O. boxes please.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this address where the fence is to be erected?
If you answered no, what is the physical address where the fence is to be erected?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Information
Property ownership status
If you rent or lease the property, please upload a copy of written permission from the property owner to build fencing for your dog. Written permission MUST include the property owner's name and phone number.

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Dog Information
Dog's Name
Breed
Age
Sex
Spay/Neutered
Upload proof of your dog's spay or neuter surgery

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Fully Vaccinated (Rabies & DHPP)
Upload proof of your dog's vaccinations.

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Veterinarian's name where services on this dog were performed:
Veterinarian's phone number
Please enter a valid phone number.Format: (000) 000-0000.
Household information
Number of Adults in household
Number of Children in Household
Approximate Annual Household Income(used solely to determine elibility):
Do you receive personal financial assistance? If so, what type(s)?

Other
If you answered "Other" in the above question, please explain what other type of assistance you get.
If you answered Medicaid, SNAP or Disability, provide proof of finanical assistance:
Proof of Financial Assistance #1
File Upload

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Proof of Financial Assistance #2
File Upload

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Eligibility Verification

Please initial each statement:
I certify that all information provided is true and complete.
I understand that Ashe Humane Society may request documentation to verify eligibility.
I own the property where the fence will be installed or I have attached written permission from the property owner.
I have confirmed that no homeowners' association (HOA), deed restriction, landlord requirement, zoning regulation, or local ordinance prohibits the installation of the proposed fence.
I understand that it is my responsibility to have all underground utility lines located before digging begins. I agree to contact North Carolina 811 (or the appropriate utility location service) before the fence is erected.
I understand that the Off The Chain Program is a one-time charitable benefit provided at the discretion of Ashe Humane Society.
I understand that approval depends upon available funding, donated materials, volunteer availability, and program priorities.
I understand that Ashe Humane Society may deny or discontinue assistance at its discretion if eligibilty requirements are not met or if false information is provided.
I agree to maintain the fence after construction and to use it to safely contain my dog.
I understand that Ashe Humane Society may reclaim the fencing if I am found to no longer be using it to secure my dog or if it is not properly maintained.
Photo Release
Applicant Certification

I certify that the information provided in this application is true and complete. I understand that submitting this application does not guarantee assistance and that any assistance is subject to the policies of Ashe Humane Society.
Signature
Printed Name
Date

MonthDayYear
Date
Please Read: You will receive an automated response that your application has been submitted to Ashe Humane Society. Our "Off the Chain" volunteer coordinator will be in touch soon about your application.
Should be Empty:

Off The Chain Application

Your Information

Property Information

Dog Information

Household information

Eligibility Verification

Applicant Certification