APPLICATION FOR FUNDING FOR LABRADOR LIFE LINE
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:

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.

General Information about the person, shelter or rescue group applying for funding:

Name: _____________________________________________
Name of Rescue Org: _________________________________
Address: ___________________________________________
__________________________________________________
City: ______________________________________________
State: _____________________________________________
Zip Code:__________________ Country:___________________
Home phone number: ____________________
Work phone number:_____________________
Mobile phone number: ____________________
E-mail address: _______________________________________
Are you above the legal age of majority in your area?  Y______ N________

2. Information on the Labrador:
Sex: M______ F________
Name:________________
Color: ________________
Age (approximation if unknown): _____________
Weight: _________________
Neutered/spayed: Y_____ N_____ If not yet neutered/spayed, will it be? Y_____ N____
If it will be neutered/spayed when will that happen? ______________________
If it will not be, why not? __________________________________________
_____________________________________________________________
Is the dog currently personally owned____ in foster care_______
in a shelter_________ other _____________
How did the dog come to be in your possession? _______________________
____________________________________________________________
How do you know this dog is a pure-bred Labrador? ___________________
____________________________________________________________
____________________________________________________________
If the dog was bought from a breeder or has papers, has the breeder been contacted? Y___ N____
If no, why wasn't the breeder contacted?__________________________________
_____________________________________________________________
_____________________________________________________________
What was the breeder's response? __________________________________
_____________________________________________________________
_____________________________________________________________Have you temperament tested the dog? Y______ N_______
Does the dog have any history of biting? Y______ N_______ fighting? Y______ N_______ fear aggression? Y______ N_____ other problems? Y_____ N_____
If yes to any of the above, please describe in detail:____________
_____________________________________________________
_____________________________________________________
What is this dog's energy level? High____ Medium____ Couch potato__
Is the dog registered with a kennel club? Y______ N_______
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:
medical care_______ supplies___________ transport__________

4. - Questions for dogs in foster care, in a shelter:
If the dog was found as a stray, is the dog tattooed or microchipped? Y___ N___
If yes, has there been an attempt to find the owner of the dog? Y___ N__
If the attempt to find the owner was successful, what was the owner's response? __
___________________________________________________________
___________________________________________________________
Are there any potential adoptive parents for this dog? Y___ N___
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? Y______ N_______
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? Y______ N_______
May we contact him/her? Y______ N_______
If so, please provide the following information on the Veterinarian:
Name:____________________________________________
Address:__________________________________________
_________________________________________________
City:______________________ State:_____________________
Zip Code:__________________ Country:___________________
Phone number:______________
email address:___________________________
Hours of operation:____________________________________
Has the dog recently been heartworm tested? Y______ N_______
If so, when and what were the results?__________________________
If the dog has not been tested, why not?_______________________________
_____________________________________________________________
If the dog is heartworm positive, do you plan to treat the dog? Y___ N____
Is the dog current on all vaccinations? Y______ N______
If not, why not?____________________________________________________
________________________________________________________________
Does the dog have any special needs? Y______ N______
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?  Y______ N______
If yes, have you applied to Care Credit?  Y______ N______
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? Y______ N_____
If so, please described in detail the condition warranting treatment:.___________
_____________________________________________________
_____________________________________________________
Was this condition a result of an injury? Y______ N_______
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? __________________________________________ 
Does the amount requested differ from the estimated cost of treatment? Y__ N__
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? Y____ N____ 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? ____________________________
___________________________________________________________
Will funding at this time enable you to retain ownership of your dog? Y__ N___
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? Y__ N__
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
foster home______ rescue group_______ shelter_______ new adoptive home______
What circumstances have occurred that necessitate moving the dog at this time? ________
_______________________________________________________
_______________________________________________________
Are you requesting funding for
air travel________
For air travel: What is the estimated costs of the air travel? __________________
Which airline are you planning to use? _______________________
Do you need a crate? Y__ N___
What amount are you requesting? ____________________________
Does the amount requested differ from the estimated cost of the transportation? Y__ N___
If yes, how will you fund the balance? _____________________________

10. - 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 Board of LLL by mail, and must be returned, complied with, signed and Dated by the applicant, to the LLL Chair before the disbursement of funds by the Treasurer of LLL is authorized by the LLL Chair.

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 return it to the Chairperson at the address you will be given. Sincerely,

Chairperson,
Labrador Life Line.