NKy Emergency Pet Resources Assistance Application
** PLEASE NOTE! WE DO NOT DELIVER. **
We do NOT provide free supplies for newly adopted, rescued, found or bought pets.
Our resources are meant to assist during struggles. Adding a new pet to a previously assisted home will cancel any further support.
Your Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Is this a cell phone or landline?
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Please Select
Cell Phone / Mobile
Landline
Email
*
example@example.com
Where did you hear about us?
City
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County
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Today's Date
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Month
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Day
Year
Date
What is your current financial situation and why you are seeking assistance from NKyEPR?
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Name, Age & Breed of Pet #1
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Name, Age & Breed of Pet #2
Name, Age & Breed of Pet #3
Name, Age & Breed of Pet #4
Name, Age & Breed of Pet #5
Name, Age & Breed of Pet #6
If necessary, please list additional pets here
Animals in your home needing assistance. NO NEW PETS will be approved. This program is for keeping pets in your home, not adding pets to a struggling situation.
Dog
Cat
Rabbit, Guinea Pig, Ferret, etc.
Food
Litter
Litter Box / Scoop
Collar / Harness
Leash
Cage / Carrier
Puppy Pads
Additional Resources Needed
Dog
Cat
Rabbit, Guinea Pig, Ferret, etc
Routine Vaccines
Monthly Preventative
Spay / Neuter Surgery
Surgical Intervention Please explain below
MEDICALLY NECESSARY Grooming
Training Concerns Please explain below
End of Life Euthanasia
Any additional info can be provided here. Please explain any Additional Resources listed above.
PLEASE NOTE: NKyEPR, will provide 1 month’s supply at a time, to help keep your pet fed, and in their home. Every effort should be made, by the applicant, to provide for the pet themselves, with NKYEPR being a TEMPORARY solution only. If we find that our resources are being misused or your are applying under false pretenses, your application will be declined and future consideration will not be made.
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Please Initial Below as Read and Accepted
AGREEMENT: By signing this application, you agree that the information provided here is true and accurate. You agree that you are not taking unneeded supplies / resources and will not attempt to profit by reselling those items. You agree, by your signature, that you will use the food and supplies for your personal pets only and not disperse them to any other person or organization. You understand your pet may receive food they are not currently consuming, and as such, agree NKYEPR is not liable if your pet experiences any issues related to difference in food type, brand, etc. You understand and acknowledge that the food you receive is provided as a charitable donation and NKYEPR holds no responsibility to your pet’s overall health, as such, from these donations.
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Date
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Month
-
Day
Year
Date
Submit
Should be Empty: