Application For Financial Assistance

First Name

Last Name

Phone Number

Email

Street Address

Apt or Suite #

City

Zip

State

County

Dog's name

Breed

Age

Weight

Sex Sex Male Female

Is your dog spayed or neutered? Is your dog spayed or neutered? Yes No

When was your dog's last grooming appointment? When was your dog's last grooming appointment? Within last 3 months 3-6 months ago 6-12 months ago More than 12 months ago My dog has never been professionally groomed

Do you believe your dog requires URGENT/Emergency grooming assistance? Do you believe your dog requires URGENT/Emergency grooming assistance? Yes No

Why are you requesting priority consideration? (Select all that apply) Why are you requesting priority consideration? (Select all that apply) Severe matting causing discomfort Skin irritation, sores, or infection concerns Nails effecting walking or mobility Elderly or medically fragile dog Owner has a medical condition preventing care Recent hospitalization or family emergency Dog recently rescued from neglect Other urgent circumstance Priority consideration may be given to dogs experiencing pain, severe matting, mobility concerns, health-related grooming needs, or emergency family circumstances. Priority status does not guarantee approval but helps us identify dogs that may require more immediate assistance.

Has a veterinarian, rescue organization, social worker, or other professional recommended immediate grooming care? ☐ Yes Has a veterinarian, rescue organization, social worker, or other professional recommended immediate grooming care? ☐ Yes Yes No

If yes, please provide details:

What services do you believe your dog needs? (select all that apply) What services do you believe your dog needs? (select all that apply) Full Groom Bath & Brush Nail Trim De-Shedding Treatment Mat Removal Ear Cleaning Sanitary Trim Other

Tell us about your dog

Which of the following best describes your situation? Which of the following best describes your situation? Fixed income/Retirement Disability or medical hardship Recent job loss Reduction in household income Family Emergency Temporary Financial Hardship Caring for multiple pets Other

Please briefly explain why you are requesting assistance at this time.

I grant Tender Tails and Wags Bakery & Grooming permission to photograph my pet and use those photos for marketing, social media, website, and promotional purposes. I grant Tender Tails and Wags Bakery & Grooming permission to photograph my pet and use those photos for marketing, social media, website, and promotional purposes. Yes

Upload Image Upload a picture of two of your dog File InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, png, mov, qt, mp4, m4v, 3gp, 3gpp, 3g2, 3gp2. Max. file size: 1 GB