RedRover Relief

Urgent Care grant application

This form can time out. If that happens the submit button will not work. You will need to refresh the page and reapply, but that will clear the application. You may want to copy the longer answers to another document (Word, Notepad, etc.) before refreshing so that you have those answers to paste into the new application.

Our business hours are 8:30 - 4:30 Pacific time, Monday - Friday. Applications submitted outside of these hours will be reviewed by our case managers as soon as possible the next business day. We review applications in the order they are received, and a reply can take 1-2 business days. Calls from RedRover will be from a 916 area code.

If an animal is in need of immediate care, where any delay will put the animal at risk, it is the owner’s responsibility and duty to seek care for the animal immediately. There is no guarantee that the RedRover Relief Urgent Care program will be able to provide financial assistance.

* Please note that n/a is not an acceptable answer to any question in this application

"*" indicates required fields

About the Pet Owner

Name*

First Last

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone Number*

Please start with the area code, do not add "1" at the beginning of the phone number.

Additional Phone Number

Please start with the area code, do not add "1" at the beginning of the phone number.

Email Address*

Is the person submitting this application 18 or older?*

Yes

Please note that the applicant must be 18 years of age or older. Minors may submit an application on behalf of an adult as long as the applicant's name is the adult's. The minor may include themselves as an alternate contact.

Is there an alternate contact for this case?*

Yes

Alternate Name

First Last

Alternate Address

Street Address Address Line 2 City State ZIP Code

Alternate Phone Number

Please start with the area code, do not add "1" at the beginning of the phone number.

Alternate Email Address

What is the relationship to the pet owner?

Have you ever received a RedRover Relief or LifeLine Grant?*

Yes

When?*

Are you applying again after a previous grant request was denied?*

Yes

How many adults are in your household?*

How many children (under 18) are in your household?*

What is the annual household income?*

If your yearly household income exceeds $60,000, unfortunately, you do not qualify for a RedRover Relief grant. Please be sure to visit www.RedRover.org/help to view our list of other financial assistance programs that may be able to help.

We understand that veterinary care is expensive. Please share information about your specific circumstances and why this care is difficult to afford.)*

Which of the following apply for you?*

Unemployed/Underemployed

Disabled

65 or over

Military veteran/Active military/Military spouse

None

(Please check all that apply.)

How did you hear about us?

Local Shelter/Humane Society

Veterinarian

Internet Search

RedRover Volunteer

Other

Other: Please Specify

RedRover is committed to Diversity, Equity, Inclusion, and Belonging. To help us ensure that our application process is accessible to as many people as possible, we invite you to answer these optional questions.

The information collected will be anonymous and will NOT impact whether or not we can help. Our case managers will not see this information with your application.

How do you publicly self-identify?

Different identity

How do you publicly self-identify?

Different Identity

How do you publicly self-identify?

About the Animal

Animal Name*

Species*

Species Other: Please Specify

Dog Breed

Dog Other: Please Specify

Cat Breed

Cat Other: Please Specify

Age*

Please enter the age of the animal in need of care. If you're not sure, please use an approximate age instead of a range. i.e. 5 not 5-6

Sex*

Female

Male

Spayed or Neutered?*

Yes

If not spayed or neutered, what are your plans to have this done?*

When did the animal join your household?*

Is this a service animal?*

A service animal is defined as a dog (or miniature horse) trained to perform a specific task or tasks to help a person with a disability. An emotional support animal is not considered a service animal.

Yes

Where did the animal come from?*

Other -please specifiy*

What does this animal mean to you and/or your family?*

Are there other animals in the home? If so, please list their species, age, and spay/neuter status.*

If available, please submit a photo of the animal.

A "regular" photo is preferred – it is not necessary to depict the injury in the photo. Max 50 MB, .gif, .jpg or .png. Press the Upload button after selecting the image to upload. Multiple images can be uploaded one at a time.

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

About the Animal's Injury or Illness and Treatment

Describe the animal's injury or illness. How did the injury occur?*

Do you have a diagnosis and treatment plan for this injury or illness that was given by a veterinarian within the last 30 days?*

Yes

If you have not yet seen a veterinarian, or if this application is requesting help with testing (x-ray, blood work, urinalysis, etc.), the Urgent Care program is unable to assist at this time. Once all testing is done, and both a diagnosis and treatment plan are in place, you are welcome to reexamine the program guidelines and submit an application.

When did this injury/illness happen?*

Is the animal being treated at the hospital now?*

Yes

When was the animal admitted to the hospital?*

Is treatment scheduled?*

Yes

When is treatment scheduled to happen?*

What treatment has been provided, if any?*

What treatment is still needed?*

What is the low end amount on the estimate of upcoming treatment?*

Please use only one number, not a range. i.e. 500, not 500-600. Please use the low/high amount on the estimate from the vet likely to do the surgery, not the lowest and highest amounts quoted from different vets.

What is the high end amount on the estimate of upcoming treatment?*

How much have you already paid for treatment for this injury/illness?*

Please use only one number, not a range. i.e. 500, not 500-600

NOT including funds already spent or donated funds, how much can you personally contribute toward the upcoming treatment?*

Please use only one number, not a range. i.e. 500, not 500-600

Have you applied for help with other organizations?*

Yes

Please list all organizations that have been applied to for financial help. Please also note if the request has been approved, declined or is still being processed, and any amounts that have been pledged toward this animal's care.*

For the best chance to raise the needed funds, we highly recommend submitting applications with multiple assistance programs. For ideas on where to apply, please visit our resource list of other financial assistance programs at www.RedRover.org/help.

If you have created an online fundraiser, please list the web links here:

Have you applied for Care Credit and been approved?*

Yes

Did not apply

For what amount?*

What is the current available credit?*

About the Clinic Treating the Animal

Clinic Name*

Clinic Address*

Street Address Address Line 2 City State ZIP Code

Clinic Phone*

Please start with the area code, do not add "1" at the beginning of the phone number.

Clinic Fax

Clinic Contact Name

First Last

If you already have an estimate for veterinary care, please attach it. Having this information will help us to process this application more quickly. (.pdf files only)

Accepted file types: pdf, Max. file size: 50 MB.

I have read and agree to the grant qualifications. By submitting this application, I agree that it has been completed in good faith. I understand that incomplete applications and/or the submission of false information may result in my application being denied.

Agree

Please note that this form can time out. If that happens you will not be able to submit the application; you will need to refresh the page and reapply. If you have to reapply, you may want to copy the longer answers to another document (Word, Notepad, etc.). That way, when you refresh the page you'll have those answers ready to copy and paste into the application.

reCAPTCHA

If you are seeing this message instead of a “Submit” button, it means that this request does not currently meet the Urgent Care grant guidelines. This is either because your pet has not recently been seen by a vet, there is not a current diagnosis and treatment plan in place, or you are asking for help with testing. Once your pet has been seen by a vet, all testing is done, and there is a diagnosis and treatment plan in place, you are welcome to reexamine the program guidelines and submit an application.

This form can time out. If that happens the submit button will not work or you may receive an error message like, "The reCAPTCHA was invalid". You will need to refresh the page and reapply, but that will clear the form. You may want to copy the longer answers to another document (Word, Notepad, etc.) before refreshing so that you have those answers to paste into the new application.