MBF Group Application

Application for Shelters and Rescues
This application is for dogs who do not have homes

Magic Bullet Fund raises funds for dogs who would not be able to have or complete cancer treatment without assistance. Funding is not immediately available - after a dog is accepted into MBF, time is needed to raise the funds for treatment.

TO APPLY:

1. Alert the veterinarian that someone from the Magic Bullet Fund might call him/her. Give your permission to freely discuss with us all aspects of your dog's case. If your doctor will not discount fees, we may be able to refer you to a doctor near you who will.

2. Same day that you complete and submit the form below, send us your Rescue Group's or Shelter's IRS non-profit letter (The 501(C)(3) status letter or an alliance letter). Email to email@themagicbulletfund.org or FAX to (914) 206-4301.

3. Fill in and SUBMIT the form below. After we receive your financial information (#2 above), we will review all information, contact your veterinarian and then contact you by phone or email.

MAGIC BULLET FUND APPLICATION FOR ASSISTANCE SHELTERS OR RESCUE GROUPS * Tab key moves from field to field. ABOUT YOUR GROUP
Group Name			If group has 501(C)(3) type EIN number. If not type "not a non-profit"
Your Name			Title (position in group)
Email Address			Re-type Email Address
Phone Number
Street Address City State Zip Does this dog have a foster family? Yes No If "No" leave 4 fields below blank Foster's Name Foster's Phone Number: Foster's Email How long has this family fostered this dog? Who has an interest in adopting this dog? Foster family Another family No one In the Magic Bullet Fund, most of the funds that come in for a dog are generated by the owner's efforts to raise donations into the dog's campaign on the Magic Bullet Fund website. Who will be in charge of spreading the word about this dog's campaign and getting donations made? Rescue Group or Shelter Foster Family

ABOUT THE DOG

Dog's Name Breed Age Weight

Sex:MF Spay/Neutered? Yes No

Date Diagnosed Type of Cancer Location (if tumor)

Treatment given up to now
Treatment Required

Other health issues:
To your knowledge, has this dog ever had cancer before? Yes No
If yes, explain

Most recent vaccinations (name of vaccines and dates given)
* We prefer that dogs with cancer are NOT given any vaccinations. Please do not vaccinate from this time on.

ABOUT THE VETERINARIAN PROVIDING CANCER TREATMENT
* Before you apply, the dog has to have been seen and diagnosed by the veterinarian who will provide the treatment.

Vet's Name	Clinic Name	Phone
Have you given this vet permission to speak with Magic Bullet Fund about this dog? Yes No * If we call your clinic and they haven't received your permission, this application will be withdrawn. Does this veterinarian provide your group with a discount? Yes No If yes, how much of a discount is provided?

If MBF does not provide assistance, how will this dog have cancer treatment?

What amount is your group or a foster family able to pay toward this dog's cancer treatment?
If the dog needs surgery, what amount can your group and foster if any pull together in the next 2 weeks?
If the dog needs chemo, type the amount that your group and foster if any can contribute each week.

How is this dog special? What would we tell sponsors to motivate them to donate?
* Limit your response to 100 words.

Do you understand and agree to the following conditions that will apply if this dog receives MBF assistance?
* * Response required * *
Yes No

If MBF agrees to raise funds for this dog, your group and/or the dog's foster family (if any) will post on the MBF Page at Facebook, will work to raise donations into the MBF campaign for this dog, will send out an email blast to all potential donators asking for donations to MBF for this dog. *If accepted, MBF will send you instructions and a sample email.
MBF funds are never used to pay past due fees, routine health care or any medical treatment that is not for cancer, palliative care, euthanasia, burial or cremation. For any treatment given and charges incurred, fees that MBF did not agree to pay are your responsibility. Fees that MBF did agree to pay will be paid directly to the clinic.
Recipients have 30 days to raise funds into the dog's MBF fundraising campaign. Donations for a dog are held on reserve for that dog's treatment fees. During the 30 day campaign, MBF will notify your group and your clinic weekly of the amount available, if new donations have increased the amount available.
MBF will attempt to gain local media attention (Newspaper, TV, Radio) for the purpose of raising donations for this dog and raising awareness of the Magic Bullet Fund. If we are successful, you agree to make this dog and a handler (shelter worker or foster family) available for interviews and photographs, and represent the Magic Bullet Fund.
When a dog no longer needs treatment, when treatment is not successful, or when a recipient doesn't comply with MBF policies, the dog's fundraising campaign is closed and any remaining funds in the campaign will be redistributed to the General Fund to help other dogs in the fund.
MBF has your express permission to discriminately and discretely share the information you send us with other carefully selected organizations, specifically and only for the purpose of raising funds for this dog's treatment.
MBF has your express permission to print or post photos and text that you send us or that you post in the MBF forum, to promote MBF.
Magic Bullet Fund is not in any way responsible for the results of this dog’s treatment, the quality of the dog’s medical treatment or any treatment side effects.

NOTE - We will not review this application until we have also received financial documents.