Pet Food Support Application

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Are you the owner of the pet you are making this application for

If you are not the owner please explain your connection with the pet

Are you in receipt of benefits

Please tell us why you need assistance

Name, breed & gender of each pet in need of support

How long have your pets lived with you

Name & Address of Vet Practice you are registered with

Does your pet have any special dietary needs or allergies (we are unable to supply raw food)

Which of the following do you need

Do you need help with parasite treatments?

Is your pet spayed / neutered

Do you agree not to resell or give away the items we provide

Would you have to rehome or surrender your pet to rescue without this service

Do you agree to provide evidence of low income

How did you hear about our pet food support service?

Our services are subject to availability & strictly offered on a one week supply basis

Please confirm that you are not a breeder

Do you give us permission to use the photograph of your pet /pets in our advertising and agree that you will not receive financial compensation for allowing us to do this

Do you understand that we rely on donations to provide food to you which is limited to availability. We can only offer you what we have at the time of application, this may be a different brand than your pet normally eats

Name Of Human Food Bank You Are Currently Using

Is there anything else you would like to tell us

Please upload picture of the pet/pets needing support

Signature

We collect your name, address, contact details, information about your pets and their food requirements, and brief information about your need for assistance. We use this information to assess your application, allocate suitable pet food, arrange delivery, manage demand and maintain appropriate service records.

Our lawful basis is our legitimate interest in operating the pet food bank fairly, safely and effectively.

Your information will only be accessible to authorised Dog Desk Animal Action directors, volunteers or delivery personnel who need it, and trusted providers that host or support this form. We will not sell your information or use your food-bank application details for marketing without asking separately.

Incomplete or unsuccessful applications will normally be deleted within six months. If assistance is provided, application and delivery records will normally be retained for up to 24 months after the final delivery, unless they are needed for longer because of a legal requirement, complaint or dispute.

You may ask us to access, correct or delete your information, restrict its use or object to its use. Contact help@dogdeskanimalaction.com.