SCVMA and Animal Health Foundation Angel Fund Grant Hospital Enrollment Form

Please fill out this page completely for consideration for Angel Fund eligibility

This application  needs to be completed and submitted once.

By filling out the information below, this hospital agrees to the following:
* Our hospital has at least one current SCVMA member veterinarian
*We agree to share information about the case and the client including a high resolution photograph of the pet and owner
*We agree to screen the client for needs PRIOR to submitting the application
*We understand there is a limited amount of funding and we are only eligible for $1000.00 per year.
*We understand that any activity that might be considered fraudulent will be reported to the appropriate authorities.
*We understand NOT everybody in need can be assisted.
*We agree to help further the AHF-SVMA Angel Fund by placing a collection jar in our lobby if asked to do so.
*We agree that our practice name and doctor's names maybe used in Press Releases created to promote the Angel Fund, Animal Health Foundation and SCVMA

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* 1. YOUR information

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* 2. I certify that all of the following have been answered truthfully and accurately.