No Place Like Home Application

APPLICATION FOR ASSISTANCE
Keeping pets and those who love them together is our mission. This routine medical and safety-net program provides critical resources to prevent pets from being surrendered to shelters or euthanized due to financial reasons.

IMPORTANT INFORMATION BEFORE SIGNING AGREEMENT

Only partial funding may be available. Upon approval, assistance costs will be covered up to $500. Unanswered questions will delay approvals. There is no reimbursement for services already rendered. Please call 941-900-8303 to confirm receipt and answer any additional questions. Leave a message with your name and pet's name if call is not answered. Keep a copy of this for your records.
I am requesting assistance for the following:*

Routine Vet Care (examples: vaccinations, heartworm test, spay/neuter)Sick Pet Visit (examples: injury, ear, skin, mouth infections)Emergency Boarding / Foster CareHelp with Apartment Pet DepositMedical Foster Care (limited to $500)Pet Food / SuppliesBehavioural TrainingMicrochipping / Free Microchip RegistrationHumane EuthanasiaShelter Impound FeesOther
Assistance for (Pet's Name)
Date*

MonthDayYear
Species*

DogCat
Primary Breed*
Gender*

MaleFemale
Pet's Birthday If Known

MonthDayYear
Date
Approx. Weight of Pet
Pet's Approx. Age*
Color / Description of Pet*
Add additional comments about pet here:
Relationship to Pet:*

OwnerFoster for Lost Pet ServicesAdopted from Lost Pet ServicesER Surrender / Foster to AdoptER Surrender / Temp FosterOther
Person Requesting Assistance*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Upload picture(s) of pet

Browse Files

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How Long Have You Owned Your Pet?

less than 6 months6 months to 1 year1 year to 5 yearsmore than 5 years
How did you acquire this pet? Be specific. Was it a found pet, an injured pet?*
Who recommended the PAWs Project to you? *
How Many in Household?*

12345 or more
Family Demographic*
Which option best describes your family type.
Pet Owner's Age:

18 - 3031 - 5556 & Above
Any Veterans in Household?*

YesNo
Any Disabled Persons in Household?*

YesNo
Housing*
Choose the option that best represents you.
What hardship do you claim? Be specific.
Total Monthly Income
Enter Zero if No Income
Do you receive government assistance/benefits:

Social SecuritySocial Security DisabilitySNAP/OtherOther
Income Document Upload

Browse Files

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PET RENTAL DEPOSIT QUESTIONS
Your Apartment Number for Reference on Check*
Name of Person or Company to issue Check for Pet Rental Deposit*
Landlord or Rental Office Phone Number *

Area CodePhone Number
Address of Rental Company/Apartment Complex to Mail Check*

Apartment Complex Name

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Due*

MonthDayYear
Date
Amount of Pet Deposit Needed*
Amount you are able to contribute*
Upload Document(s) requesting pet assisstance*

Browse Files
Please make sure that names and/or signatures are readable. May be a picture from your cell phone. Cancelof
MEDICAL ASSISTANCE QUESTIONS
Services Requested*

Routine Exam with issuesSick Visit - examRoutine - Spay/NeuterRoutine - VaccinationsRoutine - MedicationEar, Skin, Eye InfectionHeartworm TestingDental IssuesOther
What vet care is needed? Be specific*
If the pet is not spayed/neutered, do you agree to have them spayed/neutered? Spay/neuter is a mandatory requirement for assistance.*

YesNo
Is your pet current or on monthly heartworm and flea protection?*

YesNo
Is your dog up-to-date on vaccinations? Check those that apply:*

RabiesDistemperLeptoBordatellaNot up to dateOther
Is your cat up to date on vaccinations? Check those that apply:*

RabiesFVRCPFeLVNot up to dateOther
Has this pet had any vaccinations / shots? If yes, please list.
Does this pet have any health issues we need to be aware of? If yes, please list.*
Has the pet ever had surgery? If yes, please list.
Is this pet on any medications or over-the-counter medications such as topical flea sprays, ointments, or other supplements/herbs/etc? If yes, please list.
Is this pet on any medications or over-the-counter medications such as topical flea sprays, ointments, or other supplements/herbs/etc? If yes, please list.
Has this pet ever had a vaccination or shot reaction that you are aware of? If yes, please list.
Name of Current Veterinarian / Clinic*
If none, write NONE
Veterinarian / Clinic's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Last Vet Visit
Do we have permission to contact your vet?*

YesNo
EMERGENCY BOARDING / FOSTER
What is the reason for emergency boarding or a temporary foster? Be specific.*
How long do you expect boarding/foster care is needed?*
BEHAVIORAL TRAINING NEEDS
What are the exact issues you are having with your pet?*
How long have these issues been occuring?*
Do you have any funds to contribute toward training if approved?*
SHELTER INTAKE FEES ASSISTANCE
What shelter has your pet?*

Manatee CountySarasota CountyCharlotte County
What was the intake date?*
Is your pet a repeat offender?*
Has your pet been at the shelter before?*

YesNo
Under what circumstances did your pet get lost / loose / picked up? Be specific*
Can you contribute any money toward the fees? If yes, how much? If no, why not?*
REQUEST FOR EUTHANASIA
The PAWs Project will provide owners in need of financial assistance with humane euthanasia for either sick or elderly pets to cross the bridge with dignity knowing their owners have done all in their power for them.
Please give a brief description of pet's condition/situation:*
Do you have a vet or need to use one of our vets?*

We have a vetWe need to use one of your vets
Any additional questions/concerns?*
PET FOOD / SUPPLIES / ETC.
Pet food assistance and supplies such as litter, collars, leashes, gates, crates, beds, etc. may be provided.
What type of assistance is needed? Be specific.*
If food, what type of food is needed?*
If supplies, what type of supplies are needed?*
Any additional needs:*
Signature Page
RESPONSIBILITIES OF THOSE SEEKING MEDICAL ASSISTANCE

Pets must be family-owned or an approved foster of Lost Pet Services' PAWs Project. Provide updates of your pet’s health status during treatment to LPS by email, phone or text. We want to know how your pet is doing.

Must contact LPS by email, phone or text BEFORE scheduling any additional exams, rechecks, or requesting any further treatments or medications that you are unable to pay for yourself.

All care must be approved by LPS in advance or will not be funded.

Must agree to spay/neuter any unaltered funded pets within one month of treatment if not done at time of treatment. Proof of surgery will be required if done by owner. Lost Pet Services, Inc. will cover costs of fostered pets.

Lost Pet Services, Inc.
Patty Giarrusso, President
(941) 900-8303
FOR PET OWNERS - MUST READ BEFORE SIGNING AGREEMENT

Submitting an application does NOT guarantee approval. We want to help as many pets as possible, but all applications are approved or denied on a case-by-case basis. Must be able to show proof of financial need.

All questions must be answered and all documentation provided before approval or funds provided.

Please keep this and a copy of your completed application for your records. This list highlights our expectations of you, the client/owner.

When you accept funding, you have agreed to the following Owner/Client Responsibilities:

PROOF OF NEED

Must provide proof of income

ELIGIBILITY GUIDELINES

Assistance is only for one pet, per household, per lifetime.
Owner must be able to provide proper aftercare.
Pet Owner or Foster Signature*

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Please provide a thank you and tell us how the PAWs Project - No Place Like Home program helped you.
The PAWs Project (PAWs) is a collaboration between Lost Pet Services, Inc. and Whiskers and Wags Foundation, Inc. that provides funding for pets and families in crisis. Both organizations are all-volunteer nonprofit organizations that rely almost exclusively on private donations to help pets like yours. If funded, sharing your story and our mission is essential to inspire future support so more families can be spared the devastating loss of their best friend!
Please verify that you are human*
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APPLICATION FOR ASSISTANCE

PET RENTAL DEPOSIT QUESTIONS

MEDICAL ASSISTANCE QUESTIONS

EMERGENCY BOARDING / FOSTER

BEHAVIORAL TRAINING NEEDS

SHELTER INTAKE FEES ASSISTANCE

REQUEST FOR EUTHANASIA

PET FOOD / SUPPLIES / ETC.

Signature Page