Application for Halo Donation

If you are experiencing technical difficulties, please email us at We will send you an application via email to help you process one. Thank you!

    Owner Details

    Contact Name (required)

    Your Email (required)

    Phone (required)

    Shipping Address

    How did you hear about Second Chances For Blind Dogs?

    Dog's Details

    • Dog's Name

    • Dog's Age

    • Dog's Breed

    • Dog's Weight (lbs)

    What size is your dog?

    Need help measuring your dog? View Sizing Chart

    • Neck Size

    • Girth Size

      (Fattest area on the body - snug fit)

    • Profile Size

    • Backstory

    • Activity level

    Upload Photos Of Your Blind Dog:

    We may post the pictures on Second Chances For Blind Dogs' Facebook page as well as Second Chances For Blind Dogs' website.

      IMPORTANT!!! Images over (12mb) or (12,000kb) each will have to be re-sized in order to upload.

      If you are having a problem uploading photos, please crop them and resave them to make file smaller. Refresh computer and try again. If you still have issues, please text 818.943.9673 or send email to
      We will help you :)

    • Side View Of Your Dog

    • Front View Of Your Dog

    • REMEMBER! We do require pictures and video of the dog wearing the donated halo to show our wonderful Angel donor. We may post the pictures on Second Chances For Blind Dogs' Facebook page as well as Second Chances For Blind Dogs' website.

    Animal Model Release Form

    I, , (Name of Pet Owner on behalf of Animal Model) hereby irrevocably authorize Silvie Bordeaux with Second Chances For Blind Dogs and its affiliates subsidiaries, divisions, agents, representatives, producers, reporters, employees, successors and assigns to copyright, publish, reproduce, exhibit, transmit, broadcast, televise, digitize, display, otherwise use, and permit others to use, (a) my and pet’s name, image, likeness, and voice, and (b) all photographs, recordings, videotapes, audiovisual materials, any biographical material which I may provide, writings, statements and quotations of my pet or of myself (collectively, the “Materials”), in any manner, form, or format whatsoever now or hereinafter created, including on the internet, and for any purpose, including, but not limited to, all worldwide media, an unlimited number of times in perpetuity and in the promotion, advertising, sale, publicizing and promotion of Silvie Bordeaux with Second Chances For Blind Dogs, and all its affiliates, without further consent from or compensation to me.

    I hereby waive any right of inspection or approval of my appearance or the uses to which such appearance may be put and hereby agree not to assert any and all manner of liabilities, claims and demands of any kind or nature, whatsoever, in law or equity, against anyone relating to the exercise of the permissions granted hereunder.

    I further represent that any statements made by me during my appearance are true, to the best of my knowledge, and that neither they nor my appearance will violate or infringe upon the rights of any third party.

    Pet Owner name:

    Name of Pet:


    • Country:

    • City:

    • State:

    • ZipCode:


    Your Email (required)