Charly & Moose Memorial EMGP
Thank you for your interest in Piggie Poo Rescue's Charly and Moose Memorial Emergency Medical Grant Program. The EMG is available to low-income families who meet our eligibility requirements, AS LONG AS THE FUND IS SOLVENT. Funds are limited. Thank you and best wishes!
1. Please indicate the documentation that substantiates your financial hardship *
  • Food stamps (you must show a current acceptance letter)
  • AHCCCS card (you must show a current acceptance letter)
  • SSI Check
  • Unemployment Check
  • 2015 Federal Income Tax Return (individuals less than $5,000 or $11,000 for a family)
2. Name: *
3. Phone (use only this format XXX-XXX-XXXX) *
4. Street Address *
5. City, ST and Zip *
6. Email: *
7. Name of Pet *
8. Does your piggy have any of the following symptoms *
  • Hair Loss
  • Runny Nose
  • Crusty/Watery Eyes
  • Tumor/Abscess
  • Red/Swollen Feet
  • Noisy Breathing/Wheezing
  • Underweight/Not Eating
  • Broken Limb/Paralysis
  • Other - Please describe in #9
9. Please describe the physical condition of your pet. *
10. Please read and acknowledge our Emergency Medical Grant (EMG) Funding guidelines: *
  • Funding requests can only be made for animals that are in your personal care and that you have been the legal owner of for at least 30 days.
  • Amount granted will be up to 50% of the total charges, not to exceed $100.
  • You are eligible to apply for EMG once per year.
  • Recipient MUST use our Veterinarian of Record, Dove Valley Animal Hospital in Cave Creek.
  • Funds are be used to treat life threatening aliments only, and are intended to offset costs of the Office Visit, Minor Diagnostics and Medications ONLY.
  • Funds do not cover any surgical procedures, routine medical care, or cosmetic procedures.
  • Pets must survive a minimum 14 days following office visit and recipient of funds must make every effort to complete prescribed care at home as per Vet’s instructions.
  • Funds will be awarded a maximum of 50% of the total invoice of approved charges, in an amount not to exceed $100.
  • Funds will be made directly to the Veterinarian Clinic, Dove Valley Animal Hospital
  • Recipient must include Piggie Poo Rescue as an Authorized Party for Release of Medical Information from Dove Valley Animal Hospital.
  • Piggie Poo Rescue will review all procedures, prognosis, and charges prior to release of funds.
  • Grant funding is not guaranteed and is limited to funds available.
11. Please share any relevant information that you'd like us to know. *
12. I swear and affirm that the information provided in this grant application is true and complete. *
  • Yes
  • No