Veterinary Care Fund Application
Applicant Information
Name
*
First Name
Last Name
Type
*
Please Select
Individual
Non-profit
Organization (non-profits only)
EIN (non-profits only)
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Licensed Veterinarian Performing Procedure(s)
Name of Practice
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Web Address
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Procedure Information
How many castration procedures?
*
How many euthanasia procedures?
*
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Miscellaneous
Have you received assistance from the EWS Veterinary Care Fund in the past?
*
Yes
No
Is there anything else you would like to add?
I understand that this fund covers castration and euthanasia procedures only. It does not cover EIA tests, hospitalization, sedation, vaccines, trip charges, after care, antibiotics, trailering, or any other charges. Payments are made to the veterinarian directly. EWS will not under any circumstances reimburse individuals or organizations for procedures already paid in full or issue payments to anyone other than a licensed veterinarian. Application does not guarantee that funds are available.
*
Submit
Submit
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