Pet Food Bank Application | Adirondacksaveastray

Pet Food Pantry Assistance

MB Pet Food Pantry offers temporary assistance to help pet owners who are struggling to feed their pets due to financial hardship. Our goal is to help the pet owner keep their pets in their homes and out of shelters by providing assistance to those in need. This program is designed as a temporary solution and should not be viewed as a permanent source for their pets food. You will not be eligible if you are breeding, selling or flipping animals and we do reserve the right to refuse anyone under any circumstances.

First Name

Last Name

Phone

Address

Are you the pet owner, If not please explaine relationship with pet owner

Number of adults in home

Number of children in home, please included ages

Please list employeer, if you are not employed please explain how you support yourself

Monthly Household income from all sources?(You may be asked to provide proof of income)

Please explain why you are requesting pet food assistance

Please list all pets you currently have. Please include name/species/breed/gender/any special needs

How did you hear about our food bank?

I understand that the goal of the ASAS Pet Food Pantry program is to provide supplemental food to animals whose owners are in financial need and is not intended to be the sole source of food

I agree not to resell, redistribute, or attempt to return to a store, any food or care items recieved.

I understand free dog/cat food, litter and supplies will only be provided within limits of donations recieved. Therefore, Iunderstand that all pet food and supplies donated may not be the current brand i use for my pet and in acknowledgement, I accept full liability of my pets health.

I agree to provide a photo of my pet (you may include yourself) for use on our website and social media platforms. You are also agreeing to relinquish all rights to monetary gain and compensation

I agree that all informatio I have completed in this application is true and correct, and no informationhas been altered in order to qualify under the MB pet food bank assistance eligibility requirements. I understand that any false information will resuklt in termination from this program.

Upload File- Pet Picture

Your Signature

Thank you for submitting your application. Someone will reach out to you within 24 hours.