Food 4 Pets Application Your Name (required) Your Email (required) Street Address (required) City, ST, Zip (required) Phone Number (required) How did you hear about us? How many people in your household? What public assistance, if any, do you receive? Have you received help from us before? How many pets are in your household? PET INFORMATION Please list all pets in your household below, including those not requiring assistance. PET 1 Pet #1 Name Pet Type Breed Weight Age Sex Current on shots? Spayed or Neutered? PET 2 Pet #2 Name Pet Type Breed Weight Age Sex Current on shots? Spayed or Neutered? PET 3 Pet #3 Name Pet Type Breed Weight Age Sex Current on shots? Spayed or Neutered? PET 4 Pet #4 Name Pet Type Breed Weight Age Sex Current on shots? Spayed or Neutered? PET 5 Pet #5 Name Pet Type Breed Weight Age Sex Current on shots? Spayed or Neutered? PET 6 Pet #6 Name Pet Type Breed Weight Age Sex Current on shots? Spayed or Neutered? Is your pet on a special diet? If yes, please explain due to health concerns. Is there any type, brand or flavor of food that your pet(s) will NOT eat? If your pets are not spayed or neutered, would you be interested in information on a low cost voucher? If yes, please list your pets' names. Application and Agreement To be considered for assistance, you are stating that all the following statements to be true by submitting this form. We may require proof of these statements if necessary. Please check each line if you meet each qualification. I am the pet's owner. I am 18 years or older. I have a picture ID with my current address. I understand the food provided is donated and may not be your current brand, which may upset your pet's stomach. It is best to mix the donated food gradually to your current food. I agree NOT to hold Food Four Paws Pet Pantry, it's staff, volunteers or benefactors legally liable in the unfortunate event my pet becomes ill or the food upsets the pet's stomach or general health. I agree to notify the Pet Pantry if the number of pets in my household changes. I agree that I will NOT add animals for any reason while receiving assistance from F4P Pet Pantry. I agree NOT to resell the pet food received from the Pet Pantry. I agree that I do NOT breed any of my pets. I understand that the Pet Pantry has the right to deny my application. I agree to maintain healthy conditions for all of my pets or let someone know if this is not possible. I agree to give my pets fresh water daily. I agree not to tether or chain my dog 24/7. I agree to all of the above (please initial)(required) I certify that I (required) am the owner of the following pets:(required) By hitting send, I certify that all of the information provided to Food Four Paws Pet Pantry including my identification, residency and other information is true and correct. I understand that Food Four Paws Pet Pantry is not obligated to provide me with pet food. I understand that Food Four Paws Pet Pantry is a nonprofit organization that manages from donations. I do not hold Food Four Paws Pet Pantry responsible for any outcomes of taking pet food from Food Four Paws Pet Pantry. Upon approval and food distribution or F4P discretion, you must provide the following verification: Dated proof of low income (documentation must be within the last three months), food stamp, medicaid, disability, unemployment, or foreclosure, eviction or other documents approved by F4P. Photo ID with local residency or photo ID and current utility bill in your name with local residency. Proof of pet ownership (rabies vaccination, spay/neuter certificate, proof of vaccinations, proof of adoption/ownership, tags/registration, copies of vet records.