Bialy's Wellness Foundation

Helping Special Needs Animals

Application for Sponsorship

Our mission is to provide families and rescues organizations caring for special needs animals the equipment, medical care, rehabilitative therapy, training, resources and support necessary to optimize the quality of life of their pets with special needs, particularly those with mobility issues from paralysis, amputation, neurological or birth defects, and other diagnosed ailments. 

Bialy's Wellness Foundation is a non-profit funded solely on donations. Please note that submitting an application does not guarantee sponsorship and is based on the scope of our mission, financial need, and available funding. Additionally funding for approved sponsorships will be made directly to the business(es) providing services or equipment and products. 

**Please note at this time we DO NOT provide assistance for surgical procedures or orthopedic conditions.**

In order to be considered for sponsorship the following must be received:

  1. The completed application form below.
  2. Your pet's medical records supporting the request for sponsorship emailed to application@bialyswellnessfoundation.org
  3. Videos of your pet gaiting (walking) and standing emailed to application@bialyswellnessfoundation.org 

What form of sponsorship are you applying for? *
$
Name *
Name
Address *
Address
http://
Please indicate if the weight is lbs or kg.
Gender *
Spayed/Neutered? *
Fully Vaccinated? *
Available for Adoption? (if you are a rescue organization)
Is the applicant's total household income $50,000 or less? *
If you are a rescue, please email a copy of your recent organizational budget to info@bialyswellnessfoundation.org
Please include any estimates you have received for services or equipment, your costs of previous services or equipment purchased for your pet, as well as your financial situation as to why you are applying for assistance including sources of local, state and federal aid you are receiving (ie food stamps, unemployment, other).
By clicking agree and submitting this application I acknowledge the following: *
I have read Bialy's Wellness Foundation's mission statement and application guidelines. If approved, I am willing to participate in press, stories and/or updates, which may include a member of Bialy’s Wellness Foundation taking photos or videos in your home, at a veterinary clinic, rehabilitation facility or any other event pertaining to the sponsorship or submitting photos or videos as requested. If within an area where Bialy's Wellness Foundation has an established relationship with veterinary or rehabilitation services, I will take my pet to their preferred facility. I will acknowledge Bialy’s Wellness Foundation’s sponsorship on Facebook, Twitter, Instagram or any other social media platform I have access to and share their mission. I will participate in all surveys Bialy's Wellness Foundation provides in order to evaluate and continue their mission. I give permission to Bialy's Wellness Foundation to contact my veterinarian regarding my pet and give consent to release records to them for review. All information provided within this application is true, correct, and complete, to the best of my knowledge.

Copyright @ Bialy's Wellness Foundation. 2014-2017. All rights reserved. 
PO Box 220147   Chicago, IL 60622

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