YWAC Pet Pantry Application
Apply for free pet food to help you keep your pet!
Name *
Your answer
Email
Your answer
Address *
Your answer
Phone number *
Your answer
City *
Your answer
Zip Code *
Your answer
I understand that proof of income (pay stub, benefits letter, W2, etc.) is required to receive assistance from the Pet Food Pantry. I agree to bring proof of income the first time I come to pick up pet food. *
Do you receive any of the following assistance? (check all that apply) *
Required
What is your annual household income? *
Your answer
Pet #1 Information *
Pet #1 Name, age and breed *
Your answer
Is Pet#1 spayed or neutered?
Pet #2 Information
Pet #2 Name, age and breed
Your answer
Is Pet#2 spayed or neutered?
Pet #3 Information
Pet #3 Name, age and breed
Your answer
Is Pet#3 spayed or neutered?
If you have more than 3 pets please list them here with the same information as requested above.
Your answer
Name of veterinarian
Your answer
How many adults are in your household? *
Your answer
How many children are in your household?
Your answer
I understand that it is a requirement of the Pet Pantry program that my pets are spayed/neutered. If they are not, Young-Williams will provide information on low cost spay/neuter surgery and I will have 30 days to have my pet(s) spayed/neutered or will be discontinued from the program. *
I understand that I may not add any more pets to my household while receiving assistance from the Pet Pantry program *
I understand that Young-Williams Animal Center's Pet Pantry program is intended as a supplemental source of pet food and is not the sole source of food for my pets *
In the event I cannot pick up pet food I authorize the following person/people to pick up for me
Your answer
I release Young-Williams Animal Center from any claims, liability or damage relating to food I receive through the program, and I waive my right to raise any claims against YWAC *
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