Release and Authorization Form

Release, Authorization & Story Forms

Fields marked with an * are required

Companion Bridge has set forth certain policies regarding the health and medical care of all requesting financial assistance via Companion Bridge. In order to post a story and fund-raise on behalf of pet and persons requesting assistance, Companion Bridge needs full disclosure of veterinary records. Once this form is filled out correctly and you hit submit it will process and disappear. You will also receive a copy via email.

Photo/Video Release Form

If approved we will email you a request for 2 photos please fill in the fields with those 2 photos in mind.
Fields marked with an * are required

AUTHORIZATION TO USE PHOTOGRAPHS AND/OR AUDIO-VISUAL

hereby authorize

to use, reproduce, and/or publish photographs and/or video that may pertain to me and/or my pet—including my image, likeness and/or voice without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs) or for other related endeavors.
This material may also appear on Companion Bridge website, Facebook or printed documents. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, Companion Bridge may publish materials, use my name, photograph, and/or make reference to me (including your pet) in any manner that Companion Bridge deems appropriate in order to promote/publicize service opportunities.

By signing this document, you attest that you have read and understand the policies of Companion Bridge. You further understand that there is NO guarantee that all funds will be raised. You further agree that Companion Bridge is not liable  for the outcome of any medical diagnosis or treatment.

  • We cannot help until all required documents have been received and reviewed. The name address at the Vet must match the documentation. If you have recently moved you will be asked to provide proof of residence
  • We cannot help if your animal is being held at Vet until payment is made
  • We cannot pay on an invoice showing a zero balance
  • We cannot pay on Care Credit and cannot help if you have been approved for the entire amount needed by Care Credit
  • We can only pay Vets and Vendors and we cannot help if your Vet will not accept payment from us
  • We cannot help if your Vet has setup a payment plan with you
  • We can only pay for care for the diagnosis listed. If extra money is raised it will go to another companion bridge animal. Additional funds cannot be used for other services or a second pet.
  • There is a $250 cap on funds paid out from the general donation fund for non-life threatening procedures.
  • We cannot provide funds for preventative medications such as heartworm, flea and tick etc. We cannot provide funds for vaccinations, yearly bloodwork, spay /neuter or euthanasia
  • We cannot provide funds for genetic hip and knee problems i.e. non physical trauma
  • General donation funds cannot be used for long term treatments such as cancer, diabetes, respiratory etc..
  • We cannot provide general donation funds for blindness or eye issues unless the animal’s life is in danger.
  • We cannot provide funds for ongoing physical therapy beyond what was included in the original quote i.e. things such as acupuncture, chiropractic, laser etc.
  • We do not provide funds after a procedure or care has already occurred to pay off an outstanding bill.
  • We cannot pay for any elective surgeries / treatment
  • You must be 18 in order to post a story
  • We do not post any crowdsourcing links in our stories
  • We cannot help animals with breeders or that are in shelters or rescue groups
  • Stories posted can be kept up for 30 days but can be removed earlier if an animal has received treatment and been released
  • A household/family may only apply for help once
  • Companion Bridge primarily helps animals for residents of the United States in the Mid-Atlantic Area all others are still welcome to apply
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