Pet Food and Supplies Assistance Application

Comanche County Pet Resource Foundation

PO Box 6911

Lawton, Oklahoma, 73505

580-736-5499

Email: petresourcefoundation@comanchecountypetresourcefoundation.org

Website: www.comanchcountypetresourcefoundation.org
Pet Food and SUpplies Assistance Application
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Phone Number*

What Kind of Pets Do You Have?

	Pet Name	Species	Gender	Spay/Neutered?	Current on Vaccinations?	Pet's Age	Breed
Pet 1
Pet 2
Pet 3
Pet 4

Please Provide Proof of Spay/Neuter and Vaccinations for Pets Needing Assistance

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Please Provide Two Photos of Your Pet. Photos will be used for fundraising purposes *

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Please Provide Proof of Residency in Comanche County*

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Please let us know what type of food or supplies you need *
All Comanche County Pet Resource Foundation clients must adhere to the following requirements to remain active in the programs offered.
I understand that I must provide proof of current vaccinations and spay/neuter for each of my enrolled pets within 6 months of enrollment*

I understand
I understand that I must provide proof of my Comanche County residence at time of enrollment*

I understand
I understand that I may receive food for each pet only once per calendar month*

I understand
I understand that the pet food I receive is meant to be supplementary and will not cover and entire month's worth of food or be specific to my pet's dietary needs*

I understand
I understand that pet food can be picked up at Hungry Hearts Feeding Ministry in Lawton Oklahoma on the first Tuesday of the month between 11am and 1pm. Delivery of food and supplies may be requested for special cases. Deliveries occur on Thursdays only.*

I understand
I Understand that the Comanche County Pet Resource Foundation reserves the right to refuse services to me*

I understand
I understand that the Comanche County Pet Resource Foundation reserves the right to revise, change, and/or assign additional conditions to enrollment to the CCPRF Pet Assistance Program without notice*

I Understand
I understand that all pet pictures/photos may be used on social media and other platforms for the purpose of fundraising for the Comanche County Pet Resource Foundation. Pet owners will not receive any compensation for the use of pet pictures provided to the Comanche County Pet Resource Foundation.*

I understand
I,name, acknowledge and understand that any assistance I receive from the Comanche County Pet Resource Foundation is at my own discretion. I understand that Comanche County Pet Resource Foundation programs are supported by private contributions, and thus, CCPRF cannot guarantee services will be available for all programs. I also understand that pet food and supplies are received through donations and the CCPRF cannot guarantee the brand, quality, type, freshness and safety of the food provided to me. I release CCPRF, this program, and it's affiliates from all liability that may arise due to the services and products received through Comanche County Pet Resource Foundation programs.
Signature

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Date

MonthDayYear
Date

For Official Use

	Information	Comments
Client ID #
Date of Enrollment
Date of proof of residency
Date of verification of spay/neuter
Microchip number
Date of first distribution of food/supplpies/care

Should be Empty:

Pet Food and SUpplies Assistance Application