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Join the Herd - Dinosaur Application

Becoming a Dinosaur means becoming part of a family. Please fill out this application so we can learn more about you and how we can best support your needs. Please note, the information on this application will be kept confidential and only used for purposes of consideration.

First Name *

Last Name *

Date of birth

Contact Person (if not self)

Phone *

Email *

Address

Street Address

City

State

Country

Postal Code

Number of people in your household *

Ages of household members *

Are there any caregivers or support people in your household? *

Yes

No

If yes, please describe

Total monthly household income: *

Under $1,500

$1,500–$3,000

$3,000–$5,000

Over $5,000

Do you currently receive assistance programs (Medicaid, disability, food stamps, etc.)? *

Yes

No

If yes, please list:

Do you or a household member face any of the following challenges? (check all that apply) *

If other, please describe

Please tell us what kind of support would make the biggest difference for you and your family (check all that apply): *

Daily Living Support (help with meals, shopping, or transportation)

Home Support (repairs, yard work, accessibility modifications, contractor assistance)

Medical & Wellness Guidance (resources, navigating care, therapies, equipment)

Emotional Support (companionship, social connection, caregiver relief)

Community Connection (inclusive events, activities, family outings)

Financial/Resource Assistance (supplies, adaptive equipment, emergency needs)

What are the biggest challenges you face day-to-day? *

Tell us a little about yourself and why you’d like to join the Dinosaur Herd: *

By checking this box, I certify that the information provided is true and understand that all applications are reviewed based on need and location. I also consent to receive marketing and promotional messages, including information about fund raising events, volunteer opportunities and updates on Danny's Dinosaurs.

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