Emergency Foster Care Application - Harley's Hope Foundation

Apply for emergency pet boarding

Only complete applications will be reviewed.

"*" indicates required fields

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The focus of our Emergency Boarding Program is to provide assistance to pet parents who are hospitalized or recovering from a medical procedure. We can no longer offer assistance for homeless/housing issues due to the shortage of affordable housing in our area. If approved for emergency boarding, please note that we can only board dogs for 4 weeks maximum. If you cannot reclaim your animal during these time frames, please do not apply

Qualification Survey:

Are you a Colorado resident?*

Yes

We are sorry, but you do not meet our program guidelines. Please visit our Pet Resources page for a listing of other veterinary assistance programs.

Are you over 50 years of age?*

Yes

Are you a military veteran?*

Yes

Have you approached all family members/friends/co-workers for help prior to applying to this program*

Foster homes are difficult to come by. We reserve our very limited space for those without other options

Yes

We are sorry, but you do not meet our program guidelines. Please visit our Pet Resources page for a listing of other veterinary assistance programs.

Can your provide proof of financial need indicating your inability to pay for professional boarding?*

Yes

We are sorry, but you do not meet our program guidelines. Please visit our Pet Resources page for a listing of other veterinary assistance programs.

Is your pet current on all vaccinations, spayed or neutered, and can you provide proof of such?*

Dogs are required to have rabies, parvo/distemper, bordetella, and H3N2 Canine influenza vaccinations. H3N8 Canine influenza vaccination recommended. Cats must be current on rabies, FVRCP, and bordetella. Feline leukemia, FELV, required for cats allowed to go outdoors

Yes

We are sorry, but you do not meet our program guidelines. Please visit our Pet Resources page for a listing of other veterinary assistance programs.

Is your pet well-socialized to other people and animals?

Because dogs would be boarded, we strongly prefer that they get along with other dogs, and must not be aggressive towards other people. Cats must get along with people beyond the initial adjustment period

Yes

We are sorry, but you do not meet our program guidelines. Please visit our Pet Resources page for a listing of other veterinary assistance programs.

Tell us a little about yourself

Name*

First Last

Phone*

Address*

Street Address Address Line 2 City ZIP Code

How are your finances?

Total household income:*

Include income of all adults over 18 who live in the home

Are you employed?*

Yes

Estimated number of hours worked per week:*

Name of Employer*

Please upload your latest paycheck stub here

Please black-out any sensitive information like your SSN from your financial documents. If you are unable to upload this information, please email a copy to petcare@harleys-hopefoundation.org or call 719-495-6083 to make alternative arrangements.

Accepted file types: jpg, gif, png, pdf, png, jpeg, Max. file size: 50 MB.

Are you receiving public assistance of any kind?

Public assistance may be food stamps, Medicaid, housing assistance, aid for families with children, etc. that requires proof of financial need to qualify

Yes

Please upload proof of public assistance and/or financial need here:

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

What kind of assistance and how much is received monthly?

Public assistance may be food stamps, Medicaid, housing assistance, aid for families with children, etc. that requires proof of financial need to qualify

Type of assistance

Amount per month

What is your primary source of income?*

How many people, other than the applicant, live in the home?

How many are adults over the age of 18?

Do all adults work? If no, why not?

Do you own your home or car?

Yes

Are you able to borrow against this asset to pay for boarding?

Yes

Will you be able to reclaim your pet within the maximum time offered?

Dogs - 4 weeks | Cats - 6 to 8 weeks
(If you do not reclaim your animal by the end of the temporary custody contract period, or fail to stay in touch with us during this time, Harley's Hope will surrender the pet to a local shelter or animal rescue for rehoming)

Yes

Have you applied for and been denied by Care Credit?

HHF requires all applicants to apply for Care Credit and to use any approved funds prior to applying to us for assistance.

Yes

Please indicate when you applied to Care Credit

MM slash DD slash YYYY

Please attach the decline email/letter from Care Credit

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

Tell us about your pet

Pet's name*

Species*

Breed*

Gender*

Age*

Please enter a number less than or equal to 30.

Age is ...*

Months

Years

Spayed/neutered?*

Yes

Is your pet a service Animal as defined by American with Disabilities Act?*

Definition from the American with Disabilities Act

yes

Dates your pet needs emergency foster care/boarding*

MM slash DD slash YYYY

Reason you are requesting emergency foster care/boarding*

Does your pet have any behavioral issues? Please explain.*

Does your pet have special medical needs? Please explain.*

Date of last veterinary examination*

MM slash DD slash YYYY

Name of your veterinary clinic*

Phone number of veterinary clinic*

Please upload veterinary notes showing pet is spayed or neutered and current on all required vaccinations

or email veterinary notes to petcare@harleys-hopefoundation.org

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

Are cats kept indoors?*

Yes

Are dogs kept outside?*

Keeping a dog on a chain for prolonged periods of time is considered cruel and we will not accept your application. Dogs that are kept on a tether for a short period of time to do their business when there is no fence or yard, will be considered

Yes

Harley's Hope requires all funding recipients to:

1. grant permission to use your photo and your animal's photo and story in marketing and fundraising materials.

2. Write a brief testimonial regarding what it mean to you to receive this assistance from Harley's Hope.

3. Consider a future donation to HHF when your financial situation approves.

4. Agree to participate in follow-up phone calls or emails within 2 weeks of pet being returned to you and at 6 months post-assistance.. You may be asked to send updated photos at this time.

5. Agree to inform HHF if your address or phone number changes within the 6 month post-assistance period.

Do you agree to all requirements?*

I hereby certify that the answers on this application are true and correct and understand if I willingly provide false information, HHF will take legal action to recoup any funding obtained under fraudulent means. Furthermore, I agree to release Harley's Hope and its service providers, volunteers, and other representatives, from liability should the care rendered is unsuccessful or should my pet become injured while in emergency foster care.

Signature of pet's legal guardian*

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Apply for emergency pet boarding

Qualification Survey:

Tell us a little about yourself

How are your finances?

Tell us about your pet

Harley's Hope requires all funding recipients to:

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