APPLICATION FOR FUNDING FOR LABRADOR LIFE LINE

Labrador Life Line cannot be held responsible for misdirected or lost applications.  If you are not contacted by Labrador Life Line within 5 days of sending your application, contact Labrador Life Line directly.

Please save a copy of this application on your computer.  You may need to fax it directly to Labrador Life Line if any problems occur.

You will be contacted by a Labrador Life Line representative as soon as your application has been accepted for processing. This representative will give instruction as to the further information and documentation that will be needed. Unless otherwise stated, the requested information/documentation must be sent within 5 business days of the request or your application will be classified as inactive.

Guidelines for Funding
Labrador Life Line is committed to offering a variety of types of assistance to Labrador Retrievers in need. We can assist eligible Labs with medical treatment, transportation needs, boarding costs, or other special needs that will enable the Lab to find a home or to live out its life surrounded by people who love it.

In making our funding decisions, the future quality of life and not the age of the dog will be of primary importance in our evaluation. We strongly believe that no dog is disposable, and that older dogs are as important and deserving of our help and compassion as younger dogs.

Because no single organization can help every Labrador Retriever in need, Labrador Life Line has adopted some eligibility guidelines. We will assist purebred Labrador Retrievers who are
with an individual, family or life partners but for valid reasons,
(a) the family/individual/life partners cannot provide the required help for the dog's condition;
(b) currently or will be placed in rescue situations;
(c) are currently at a shelter.

Other funding eligibility guidelines include:

  1. The dog is or will be placed in a rescue situation or with a family/individual/life partners who cannot provide the required help needed for the dog's situation.
  2. The dog is not terminally ill.
  3. The dog is adoptable.
  4. If the dog is not currently owned, the dog is or will be adoptable if medical treatment is received (this may require consulting with the attending veterinarian or further written documentation).
  5. The dog is not or has not been aggressive towards people or other dogs.
  6. Funds will not be used to treat diseases that Labrador Life Line regards as genetically based and for which risk can be significantly decreased through testing and careful breeding. This includes, but is not limited to hip dysplasia, elbow dysplasia, osteochondrosis dessicans, juvenile cataracts, progressive retinal atrophy, and retinal dysplasia.
  7. LLL is in place to provide funding for Labradors whose families or rescues have no other way to pay for necessary care. As such, we will not provide funds for dogs whose rescuers or family have alternate methods of payment - and we cannot pay for procedures for which the veterinary clinic has already received payment.
  8. Funds will not be used for long term medical needs.
  9. The future quality of life and not the age of the dog will be will be of primary importance to the Committee in its evaluation. Labrador Life Line strongly believes no dog is disposable, and that older dogs are as important and deserving of our help and compassion as younger dogs.
  10. Funding amounts differ for rescues and owned dogs.
    - For an owned dog, funding is typically for up to 75% of the proposed therapy with a maximum funding per case of $1,000 except for cranial cruciate ligament rupture therapy in which the maximum is $750
    - For a dog in rescue, funding is typically for up to 50% of the proposed therapy with a maximum funding per case of $500 including for cranial cruciate ligament rupture therapy in which the maximum is $500.
    All applicants will be responsible for providing assurance that the balance of the medical costs can be paid before funds will be released.
  11. If the situation is deemed life or death, the President of the Labrador Life Line Board can release funds without approval of any/all Committee members.
  12. All dogs whose health allows must be spayed/neutered before funds will be released. If a dog is not spayed/neutered and is not able to be spayed/neutered immediately due to health concerns, the applicant must provide LLL with both a veterinary opinion saying that the dog cannot currently be neutered and written agreement that the dog will be spayed/neutered as soon as his/her health permits. With the exclusion of a dog that has been rescued, responsible pet ownership entails spay/neuter of a pet, proper routine care including yearly vaccinations, heartworm testing and heartworm preventative (where heartworms are considered a significant health risk by veterinary authorities) and proper confinement. LLL is not able to assist in funding routine care.
  13. Due to volume of requests we receive, we must impose a limit on the amount of funding each group or individual can receive in a year. The number of approved cases and/or dollar limit is set by the board on an annual basis. LLL's purpose is not to replace or supplement fund raising efforts of rescue groups or individuals, but to be a 'life line' in emergency situations. By not revealing this limit, it is the intent of LLL to have applicants be selective in their applications.
  14. Funding will only be considered when treatment has been done under the following conditions:
    - The applicant must provide written documentation from the veterinarian that treatment was of an urgent nature (meaning it could not wait for funding to be approved or money otherwise raised to cover the cost without endangering or causing significant discomfort to the lab).
    - The treating veterinarian does not provide any type of payment plan which can include carrying account balances; partial, monthly or delayed payments; post-dated checks.
    If an individual has made payment by credit card, received Care Credit (or similar) on behalf of a rescue organization or individual, a payment plan will be considered in place

You will be notified in a timely manner if it is determined that your dog meets our criteria.

Labrador Life Line reserves the right to revoke approval of funding for any reason prior to the lab's treatment. Reasons for revocation include, but are not limited to:

Please note that because this application is being submitted via the internet, a typed signature will be considered as legally binding as a handwritten signature.
Applicant Signature
In providing your signature you confirm that you have read, understand and agree to Labrador Life Line's Guidelines for Funding. LLL does investigate all applications, obtaining verification from veterinary clinics of proposed treatments and costs. In all cases the veterinary clinic will be asked for verification of the availability of payment plans, and if the clinic has already received payment for the procedure in question. Please note that un-signed applications will not be considered.
 
1. General Information about the person, shelter or rescue group applying for funding:
Name:
Name of Rescue Org:
Address:
City:
State/Province/
Country:
Zip/Postal Code:
Home phone number:
Work phone number:
Mobile phone number:
E-mail address:
Are you older than the legal age of majority in your area? Yes  No
2. Information on the Labrador Retriever:
Dog Sex: Male Female
Name:
Color:
Age (approximation if unknown):
Weight:
Neutered/spayed: Yes No
If not yet neutered/spayed, will it be? Yes No N/A
If it will be neutered/spayed when will that happen?
If it will not be, why not?
Is the dog currently:
How did the dog come to be in your possession?
How do you know this dog is a pure-bred Labrador Retriever?
If this dog was bought from a breeder or has come with registration, have you contacted the breeder? Yes No N/A
If no, why wasn't the breeder contacted?
If yes, what was the breeder's response?
Have you temperament tested the dog? Yes No
Does the dog have any history of:  
If yes to any of the above, please describe in detail:
What is this dog's energy level?
Is the dog registered with a kennel club? Yes No Unknown
If yes, which kennel club is the dog registered with?
If the dog is in foster care or a shelter, why do you consider this dog adoptable?
 
3. - Are you requesting assistance for:
 
4. - Questions for dogs in rescue, foster care or in a shelter:
If the dog was found as a stray, is the dog tattooed or microchipped? Yes No N/A
If yes, has there been an attempt to find the owner of the dog? Yes No N/A
If the attempt to find the owner was successful, what was the owner's response?
Are there any potential adoptive parents for this dog? Yes No N/A
If yes, please describe
If the dog is in foster care, how long can the dog remain in the current foster situation?
Who will be responsible for the dog if the current foster care situation does not work out?
What will happen to the dog if the foster care situation changes?
If the dog is in a shelter is this a no-kill shelter? Yes No N/A
If the dog is in a shelter that euthanizes, what is the length of time that a dog is held in the shelter?
If the dog is in a shelter that euthanizes what guarantees are there that the dog will not be euthanized if not adopted within that set period of time?
 
5. - For all applicants - Medical History of the Dog:
What is the dog's current health status?
Has the dog recently been seen by a veterinarian? Yes No
May we contact him/her? Yes No
If so, please provide the following information on the Veterinarian:
Name:
Address:
City:
State/Province/
Country:
Zip/Postal Code:
Phone number:
E-mail address:
Hours of operation:
Has the dog recently been heartworm tested? Yes No
If the dog has not been tested, why not?
If the dog is heartworm positive, do you plan to treat the dog? Yes No N/A
Is the dog current on all vaccinations? Yes No
If not, why not?
Does the dog have any special needs? Yes No
If yes, please explain them:
 
6. - For all applicants - Financial History:
If Care Credit is available through your veterinarian, we will need proof of application and the amount approved for. If Care Credit is not available through your veterinarian, we will need written confirmation from him/her that it is not a financing option.
Is Care Credit available through your veterinarian? Yes No
If yes, have you applied to Care Credit? Yes No
If Care Credit is available and you have not applied, why have you not applied?
Please tell us about the special financial circumstances that you feel make this dog applicable for funds:
Please detail your previous attempt(s) at raising funds for the dog's care, including a payment plan with the veterinarian, if applicable. If no attempt has been made, please detail why:
 
7. For those applicants applying for medical assistance:
Has medical or surgical treatment been recommended for the dog? Yes No N/A
If so, please described in detail the condition warranting treatment:
Was this condition a result of an injury? Yes No N/A
If so, please describe in detail how the injury occurred:
What is the expected outcome of treatment for this dog?
What is the cost of the required treatment?
Who is primarily responsible for that cost?
What amount are you requesting (note: LLL normally only funds up to 50% of the treatment cost on approved cases)?
Does the amount requested differ from the estimated cost of treatment? Yes No N/A
If yes, how will you fund the balance?
Have you applied for other sources of funds other than LLL, either before or after applying to LLL? Yes No N/A
If yes, please list source(s) and the contact person's telephone number and email:
In the event that other sources of funding are applied for, and/or received, after or during case work up, LLL must be notified.
 
8. For those applicants applying for the cost of supplies:
Please list the supplies you are requesting funding for:
What circumstances have occurred that necessitate asking for funding at this time?
Are these circumstances permanent or temporary? Permanent  Temporary N/A
Will funding at this time enable you to retain ownership of your dog? Yes No N/A
If yes, please explain in detail:
What is the estimated costs of the supplies?
What were your sources for estimating the cost of these supplies?
What is the expected outcome of obtaining these supplies for this dog?
What amount are you requesting?
Is this amount different from the estimated cost of these supplies? Yes No N/A
If yes, how will you fund the balance?
 
9. For those applicants applying for help with transportation (please make sure you have filled in section 4 as we only provide transportation for rescue Labradors):
Where is the dog currently located? (city, state, country):
Is the dog going to a:
What circumstances have occurred that necessitate moving the dog at this time?
Are you requesting funding for
air travel?		 Yes No N/A
For air travel: What is the estimated costs of the air travel?
Which airline are you planning to use?
Do you need a crate? Yes No N/A
What amount are you requesting?
Does the amount requested differ from the estimated cost of the transportation?
If yes, how will you fund the balance?
10. - Is there any other information that would be useful in our decision making process?
   
I ACKNOWLEDGE THAT ALL THE INFORMATION ON THIS FORM IS TRUE AND CORRECT. I UNDERSTAND THAT ANY MISREPRESENTATION OF FACT MAY RESULT IN MY NOT BEING APPROVED FOR FUNDING. WE RESERVE THE RIGHT TO REFUSE OR DENY ANY APPLICATION THAT DOES NOT STRICTLY MEET OUR GUIDELINES. ACCEPTANCE OF APPLICATION BY LLL DOES NOT GUARANTEE FUNDING. ATTENTION: All successful applicants will be required to sign a Release of Information form in which the applicant agrees to the sole possession and use of certain Specified data by LLL such as but not limited to the dog's name, medical condition, rescue history, etc.; an Agreement to Terms and Conditions form in which the successful applicant will, among other things, provide verification that the specific purpose for which LLL has awarded the grant has been accomplished or performed (billing statement/affidavit, e.g.); agrees the LLL grant will be used only for the specific purpose in their application; agrees to reimburse LLL the full amount of the grant if any negligent, reckless, or intentional effort to misrepresent or misstate material facts contained in the application, and any and all fees that may be incurred by LLL in recovering those funds. These documents will be sent to the successful applicant by the Chairperson of the Triage Committee of LLL via the internet, and must be returned, complied with, signed and Dated by the applicant, to the LLL Triage Chair before the disbursement of funds by the Treasurer of LLL is authorized by the LLL Triage Chair.

I further agree that my typed signature will be considered legally binding.

 
Signature:
Date:
 

RELEASE OF INFORMATION

As stated above, this information is required before funds are released.

By affixing your signature to this document, you are agreeing to the following terms and conditions:
1. You must provide written verification that the funds have been used for the specific purpose(s) as set forth in your application. For example, if the grant is for a medical treatment, an invoice from your veterinarian's office listing the costs and procedures is sufficient. Other documents may vary according to the purpose funded.
2. The funds must be used only for the purpose(s) specifically applied for and approved by the Board of Directors. No other additional charges or payment for services, treatments or items may be added without LLL Board approval. Failure to fully comply with this condition may result in your full reimbursement of the grant amount to Labrador Life Line, plus any additional legal or administrative fees incurred by LLL.
3. Your signature on this document serves as binding legal testament that all the information provided on this form, and in subsequent written, oral, and electronic communications with LLL board and committee members, is complete, true, and accurate, to the best of your knowledge. Any grossly negligent, reckless, or intentional misrepresentation or omission of a material fact will immediately result in the withdrawal of your application from the evaluation process. If the discovery of such inaccuracies, omissions, or misrepresentations takes place subsequent to the disbursement of funds by LLL, you will promptly reimburse LLL for the full amount of the grant, plus any administrative or legal fees incurred by LLL in the course of pursuing this matter. RELEASE OF INFORMATION In affixing your signature to this document you are assenting to the following terms governing the release of information by Labrador Life Line:
1. Labrador Life Line is permitted to use, without compensation to the applicant, any photographic material submitted as part of the application for publicity, educational, fund raising, and other legitimate corporate purposes. Labrador Life Line has all rights to these photographic materials unless otherwise agreed. Labrador Life Line may publish these pictures on its Internet web page site, brochures, or other promotional and educational materials.
2. Labrador Life Line is permitted to use, without compensation to the applicant, the following information concerning this application:
a. The name, sex, color, and other personal characteristics of the applicant's Labrador Retriever.
b. The information relating to the reason(s) why the applicant is seeking LLL funds to aid their Labrador Retriever. This can, but is not limited to, a description of the physical condition and the prescribed treatment; information relating to how the applicant obtained ownership of the Labrador Retriever; or anecdotal stories concerning the relationship between the applicant and the Labrador Retriever.
c. Other such information that LLL and applicant can agree as to its publication and use by LLL to further its mission of raising funds to help Labrador Retrievers in need.
d. Labrador Life Line agrees to hold confidential the name(s), address, phone number, fax number, and email address of the applicant unless otherwise granted permission to use this and other personal information for legitimate LLL corporate purposes.
e. Labrador Life Line may publish non-confidential information on its Internet web site, or in other promotional or educational materials. Once you have signed this document, please submit it to the Triage Chair via the internet form.

Sincerely,
Triage Chair,
Labrador Life Line.