CARE Request Form

LCAS is expanding the CARE program to help families affected COVID-19. If you are struggling to provide necessary care for your companion animal you can apply for a grant from the CARE program. Loudoun County residency is the only requirement. 

Grants available on a first come, first serve basis.

You will be contacted within 1 business day once you have completed this form. Please include accurate contact information.

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* 1. What is your name? (First and Last name)

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* 2. What is your address? You must be a Loudoun County resident to receive assistance through the CARE program.

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* 3. What is your phone number?

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* 4. What is your email address?

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* 5. Pet 1 - Fill out the information below for each pet you are requesting assistance for:

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* 6. Pet 2 - Fill out the information below for each pet you are requesting assistance for:

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* 7. Pet 3 - Fill out the information below for each pet you are requesting assistance for:

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* 8. What are you requesting funds for? Funds may be approved for medical needs, prescriptions, prescription food and certain other pet wellness supplies. Please be detailed.

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* 9. What vet clinic do you currently use?

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* 10. What is the estimated cost of the needs listed above?

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