FOOD ASSISTANCE PROGRAM
Welcome to Companion Pets of Cleveland Food Assistance program.

Your membership allows a monthly pickup of dry and or wet food for your pet(s) for one year. Because we are donation-based, we cannot promise specific food types or name brands.

The application you will fill out has many questions regarding you and your pets. There are no judgments, and the statistical information provided from your answers will be used in the future to secure grant funding, partnership opportunities, spay/neuter program expansion, additional public service opportunities, etc..

We will contact you once the form is received to schedule an appointment to pick up food. This allows us to make sure we have what you need. You will receive a welcome letter with a membership ID # and a resource sheet at your first pick up..

When you need more food please use our Food Assistance Reorder form via the Companion Pets of Cleveland website. If food availability becomes an issue, you will be given a Resource guide that lists many services available in the Northeast Ohio area.

VIP Petcare administers both cat and dog vaccines at their office twice a month: FVRCP, leukemia and Bordetella. They insert Microchips and do Heartworm tests for dogs and FeLv/FIV tests for cats.

TRANSPORTATION: It is your responsibility to have reliable transportation to the pantry. If their are extenuating circumstances, please discuss them with a CPOC representative.

We believe in this program and would like to see it continue!

Bob Stevens
Founder, Executive Director

Carol Rini
Food Assistance Program Chair
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NAME (Legal Owner) *
STREET # and NAME *
CITY, STATE & ZIP *
EMAIL ADDRESS *
PHONE: HOME or CELL *
CAN WE TEXT THIS NUMBER *
HOW WOULD YOU LIKE TO HEAR FROM US PRIMARILY? *
GOVERNMENT ASSISTANCE (SELECT ALL THAT APPLIES) *
Required
ARE YOU A MILITARY VETERAN? *
HOW DO YOU IDENTIFY? *
AGE RANGE *
NAME OF PET #1 *
SPECIES OF PET #1: *
Required
GENDER of PET #1: *
Required
APPROX. AGE OF PET #1: Years, Months or Weeks? *
APPROX. WEIGHT OF PET #1: *
IS PET #1 THE SIZE OF: *
BREED of Pet #1: Tabby, DLH, DMH, DSH, Calico, etc.? *
COLOR of Pet #1 *
IS PET #1: *
Required
CPOC IN PARTNERSHIIP WITH VIP PETCARE OFFERS VACCINATIONS, MICROCHIPS & MORE FREE OF CHARGE. Select ALL that apply: *
Required
NAME of PET # 2:
SPECIES of PET #2:
GENDER of Pet #2:
APPROX. Age of Pet #2: Years, Months or Weeks?
APPROX. WEIGHT of PET #2:
IS PET #2 THE SIZE OF:
Clear selection
BREED of Pet #2: Tabby, DLH, DMH, DSH, Calico, etc.?
COLOR of Pet #2
IS PET #2:
CPOC IN PARTNERSHIIP WITH VIP PETCARE OFFERS VACCINATIONS, MICROCHIPS & MORE FREE OF CHARGE. Select ALL that apply:
NAME of PET #3
SPECIES of PET #3:
GENDER of Pet #3:
APPROX. Age of Pet #3: Years, Months or Weeks?
APPROX. WEIGHT of Pet #3:
IS PET #3 THE SIZE OF:
Clear selection
BREED of Pet #3: Tabby, DLH, DMH, DSH, Calico, etc.?
COLOR of Pet # 3
Is Pet #3:
CPOC IN PARTNERSHIIP WITH VIP PETCARE OFFERS VACCINATIONS, MICROCHIPS & MORE FREE OF CHARGE. Select ALL that apply:
NAME of PET #4
SPECIES of PET #4
GENDER of PET #4
APPROX. Age of Pet #4: Years, Months or Weeks?
APPROX. WEIGHT of Pet #4:
IS PET #4 THE SIZE OF:
Clear selection
BREED of Pet #4: Tabby, DLH, DMH, DSH, Calico, etc.?
COLOR of Pet # 4
Is Pet #4:
Clear selection
CPOC IN PARTNERSHIIP WITH VIP PETCARE OFFERS VACCINATIONS, MICROCHIPS & MORE FREE OF CHARGE. Select ALL that apply:
ADDITIONAL PET's (Please include name, species, weight, age, spay/neutered, breed) If no use N/A. *
Do any of your pets require a special diet or on a medicated food? If no use N/A: *
WHAT DO YOU NEED? (Select All That Apply) *
Required
HOW DID YOU HEAR ABOUT CPOC? *
VETERINARIANS NAME & PHONE NUMBER:
Any additional information you wish to share? If no use N/A: *
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