Ranch Family Application Form

In this form you can apply for assistance or nominate a family for assistance. Please provide all the information you can about the situation. The more specific you are on the need of the family, the better. A lot of people doing a little makes a huge difference.

Ranch Family Information


Ranch/Employer Information

Contact Person(Required)

Applicant Information

Reason for Diagnosis (Please Select All that Apply)(Required)
Diagnosis Resulted in (Please Select All that Apply)(Required)

Applicant Questionnaire

Donation Recipient

Person to Receive Donation(Required)

Release of Information

By submitting this application, I the undersigned, authorize His Cavvy Foundation to share its contents with its Board Members. Donations of funds by the His Cavvy Foundation are entirely discretionary. I understand that I am not guaranteed a monetary donation by submitting this application. The signatory represents and affirms that all information submitted in this application is true and correct. By signing your name electronically below, you are agreeing that your electronic signature is the legal equivalent of your manual signature on this application form.
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Personal information collected as part of the application process will become property of His Cavvy Foundation, and will be used by its Board Members for purposes of evaluating applicants. The Board Members have the final decision, and will evaluate each medical situation per incident, and its decision on each application is final.
This field is for validation purposes and should be left unchanged.