Registration Form-PFF

Community Health and Empowerment Network Inc., (CHE) Pet Supportive Services Project

info@healthempowermentnetwork.org
We are offering temporary pet food/supplies to Miami-Dade County Residents who are in need.

Please complete this form, so we can contact you with pick-up and distribution information.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Type of Pets
Number of Pets
Income

Less than $20,000 to $34,999$35,000 to $49,999$50,000 to $74,999$75,000 to $99,999
Please note that we cannot donate to anyone who is breeding, selling, or flipping animals. We also reserve the right to refuse anyone under any circumstance. Pet food recipients cannot take on additional animals while receiving assistance. Agree not to hold CHE and its volunteers liable in the unfortunate event your pet(s) become ill or the food upsets a pet(s) stomach. Recipient agree not to resell, redistribute, or return to a store the food items received from CHE. Should you violate any of these requirements, assistance will be terminated immediately.
Please select yes if you understand and agree to these terms
For any questions, please contact info@healthempowermentnetwork.org/

(786) 320-2003
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Community Health and Empowerment Network Inc., (CHE) Pet Supportive Services Project