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Harley's Hope Foundation   ©   2010 - 2017   •  All Rights Reserved

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The focus of our Emergency Foster Care program is to provide for pet parents who are hospitalized or recovering from a medical procedure.  We may be able to help in short-term emergencies and will review on a case-by-case basis. If approved for emergency foster care, please note that we can only keep animals for six weeks or less. We are not equipped to provide long-term care.

All animals coming into emergency foster care must be current on vaccinations, in good health (some chronic health conditions may be accepted), and be well socialized.  We cannot accept pets with severe separation anxiety, a history of biting or attacking, or aggression towards other animals. 

We can no longer assist with housing issues.  Due to the shortage of affordable housing in Southern Colorado, housing cases are extending out far too long.  Because of this and the demand for assistance with housing cases, we can no longer provide this help

Complete the application in its entirety and provide the following:

•  Proof of financial need (recent paystub, recent bank statement, SSI/SSDI award letter, food stamp card, other public assistance cards or award letters. Be sure to block out your Social Security Number.)
•  Veterinary notes indicating pet is current on vaccinations and is spayed/neutered
•  Digital photo of your pet, if available.


Applications that are not complete or are not accompanied by the required documentation will not be reviewed.
You must submit all the required documentation within 24 hours after you submit your application or your application will be declined.

Submit your application:
•  Online at http://www.harleys-hopefoundation.org/fostercareapplication.html (If you submit your application online but are unable to upload documents, you may email or fax them.)
•  Or Email to services@harleys-hopefoundation.org
•  Or Fax to (719) 495-5945
QUALIFICATION SURVEY:
  YES NO
• Have you approached all family members/friends/co-workers for help prior to requesting foster care from Harley’s Hope Foundation?
Foster homes are difficult to come by. We reserve our space for those without other options who might otherwise be forced to give up their companion/service animals.
     
Can you provide proof of financial need indicating your inability to pay for professional kenneling/boarding services?

If you have answered “No” to any of the qualification survey questions, do not submit your application.

Do not leave any questions blank. If the question does not apply, answer “n/a”

 

CLIENT INFORMATION:
Name
Address
City
State
Zipcode
Phone Number
Email Address
   
Total Household Income:
(Include significant other/spouse's income)
Employed? Yes    No
Hours per week:
PLEASE UPLOAD YOUR LATEST PAYCHECK STUB HERE:

OR EMAIL YOUR LATEST PAYCHECK STUB TO services@harleys-hopefoundation.org

Name of Employer:
Address of Employer:
   
Are you receiving public assistance of any type? Yes    No
What kind?  Amount: Frequency:
Please UPLOAD PROOF OF PUBLIC ASSISTANCE AND/OR FINANCIAL NEED HERE: 

OR EMAIL Proof of Public Assistance and/or Financial Need TO services@harleys-hopefoundation.org

What is your primary source of income? 
   
How many other people live in the household?
How many are adults?
Do adults work? Yes    No
If not, why not?
Do you own or rent your home? Own    Rent
Do you own a vehicle? Yes    No
Will you be able to reclaim your animal within the maximum length of time from date of surrender?
Dog – 4 weeks maximum
Cat – 6 weeks maximum
If we take your animal into foster care and you fail to stay in touch or reclaim your pet at the agreed upon date, HHF will surrender custody of the animal to a local shelter or rescue for rehoming.
Yes    No
   
Have you requested financial assistance from other agencies, including Care Credit, credit cards, or individuals to treat this particular issue? You must have exhausted all other options prior to applying to Harley's Hope Foundation. Please indicate to whom you have applied, the date of approval or denial and any monies received.
Individual/Organization Date of Approval/Denial $ Received



PET INFORMATION:
Name of Pet
Species:
Breed:
Gender: Male  Female
Age
Spayed/Neutered? Yes   No
* Service Animal? Yes    No
*Based on the definition under Title II of the Americans with Disabilities Act, a service animal is a dog or miniature horse, individually trained to perform tasks related to the person’s disability.
If yes, what tasks has the animal been trained to do for you?
   
Dates your pet needs to be boarded
Reason for requesting emergency foster care:  
Is your pet socialized with humans and other animal? Humans    Dogs     Cats
Does your pet have any behavioral issues? Yes    No
If yes, please explain
Does your pet have any special medical needs? Yes    No
If yes, please explain
Is your animal up to date on vaccinations? Yes    No
Date of Last Exam:
(If your pet has gone more than 18 months without seeing a veterinarian, you do not qualify. Please do not complete the application.)
Name of your Veterinarian/Veterinary Clinic
Address of your Veterinarian/Veterinary Clinic
Phone Number of your Veterinarian/Veterinary Clinic
(Applicants must have an established relationship with a veterinarian in order to qualify for assistance.  Please note we may contact your veterinarian to confirm that they have treated your animal.  If you have recently moved and have not yet found a veterinarian in your new location, please list your most recent veterinarian.)
   
Species and number of other pets in the household:
Are all other pets spayed or neutered? Yes    No
Are cats kept indoors? Yes    No
If no, please explain
Are dogs kept outside? Yes    No
If yes, please explain
Are dogs kept chained? Yes    No
If yes, please explain
Do dogs ride in the back of trucks? Yes    No
If yes, please explain
   

 

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.  Consider a future monetary donation when your financial situation improves.
3.  Consent to follow-up phone calls/emails from a HHF representative within 2 weeks, 6 months and 1 year post-assistance. If HHF does not hear back after two attempts to contact you, you will not be eligible for any future assistance from Harley’s Hope Foundation.
4.  Inform HFF if your address or phone number changes during the 12 month post-assistance period.
5.  View educational pet care workshops offered through HHF’s annual HOPE Series available on YouTube or HHF website.

Do you agree to all requirements?     
Yes    No

Check here if you certify below:

I certify that the answers on this application form are true and correct, and understand if I willingly provide false answers, Harley's Hope Foundation will take legal action to recoup the funding obtained under fraudulent means. Furthermore, I agree to release Harley’s Hope Foundation and its service providers (veterinarians, trainers, and fosters) from liability should the veterinary care, emergency foster care, or behavioral training rendered prove unsuccessful or the animal becomes ill or injured while in our care.

 

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