Office 8, Level 1, 43 Williamson Street, Bendigo 3550 info@thebushfirefoundation.org PO Box 455 Bendigo 3550

RELIEF SUPPORT

If you require disaster relief for your animals please fill in the form below and a member of our team will contact you as soon as possible for any follow up questions and to discuss when is a good time for us to meet with you.
Name*
Phone*
Email*
Number of animals needing assistance*
Type of Animal*
Is Animal Registered (micro-chipped)*
Assistance Required*
If Other please describe below*
Additional Comments
Permission to pass on Information
Name*
Date Field
I consent to The Bushfire Foundation Inc using the Information i have supplied for the purpose of distributing it to other members of there teams for the use to supply there services and programs.