Request for Food Assistance.

Request for Food Assistance

The Dog Stays is a donation-based 501(c)3 nonprofit dedicated to helping dogs (and sometimes cats) in Webster, Christian and Greene Counties in Missouri. If you need food assistance for your pets, please fill out this application for help. If you need assistance with more than pet food, please fill out our Request for Assistance form at www.TheDogStays.org Thank you!
Date*

MonthDayYear
Date
Name*

First NameLast Name
Your Age*

18-2526-3334-4445-5556-6464+
Are you the head of household*

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The address above is:

My permanent residenceMy mailing addressSomeone else's addressMy temporary residence
Email
example@example.com
How did you hear about us?*
We understand that your pets are cherished members of your family, and we want to ensure they receive the care they need. You may apply for food assistance for up to four pets. If you have more than four pets, please feel free to share their details at the end of this application. For each pet you need assistance for, we kindly ask that you provide specific information. This will help us better understand their unique needs and allow us to support you in the best way possible. Thank you for reaching out to us during this time; we are here to help you care for your beloved companions. The Dog Stays does help with spay/neuter and vaccinations, if needed.
Pet #1 Information*

Pet Name, Pet Age, Pet Breed, Pet Type(dog or cat?)

Vaccination Information: Is this pet up to date on vaccines? Needs vaccines updated? Never vaccinated?

How long have you owned this pet?Gender? Is this pet Spayed or Neutered?

What Veterinarian do you currently use?
Please check ALL that apply for pet #1*

This pet is up for adoption.I can no longer care for this pet and need further assistance.This is someone else's pet.I need to sell this pet.None of the above.
Pet #2 Information

Pet Name, Pet Age, Pet Breed, Pet Type(dog or cat?)

Vaccination Information: Is this pet up to date on vaccines? Needs vaccines updated? Never vaccinated?

How long have you owned this pet?Gender? Is this pet Spayed or Neutered?

What Veterinarian do you currently use?
Please check ALL that apply for pet #2

This pet is up for adoption.I can no longer care for this pet and need further assistance.This is someone else's pet.I need to sell this pet.None of the above.
Pet #3 Information

Pet Name, Pet Age, Pet Breed, Pet Type(dog or cat?)

Vaccination Information: Is this pet up to date on vaccines? Needs vaccines updated? Never vaccinated?

How long have you owned this pet?Gender? Is this pet Spayed or Neutered?

What Veterinarian do you currently use?
Please check ALL that apply for pet #3

This pet is up for adoption.I can no longer care for this pet and need further assistance.This is someone else's pet.I need to sell this pet.None of the above.
Pet #4 Information

Pet Name, Pet Age, Pet Breed, Pet Type(dog or cat?)

Vaccination Information: Is this pet up to date on vaccines? Needs vaccines updated? Never vaccinated?

How long have you owned this pet?Gender? Is this pet Spayed or Neutered?

What Veterinarian do you currently use?
Please check ALL that apply for pet #4

This pet is up for adoption.I can no longer care for this pet and need further assistance.This is someone else's pet.I need to sell this pet.None of the above.
Have you applied for assistance with us before? If yes, when?*
How long do you anticipate needing food assistance?*
Please tell us why you need assistance?
What other agencies are assisting you with pet food?
I understand ALL pets in the household MUST BE spayed/neutered. Proof is required.*

My pet(s) are spayed/neuteredMy pet(s) are NOT spayed/neuteredI'm requesting a one time exceptionI have special circumstances
I understand ALL pets in the household MUST have a rabies vaccinatiobn. Proof is required.*

My pet(s) is/are vaccinatedMy pet(s) is/are NOT up to date on their rabies vaccination(s)I'm requesting a one time exceptionI have special circumstances
I understand food received is intended to supplement my own food supply. It is my responsibility to determine how to allocate the food I receive.*

I understandI disagree with these terms.
I understand that there are specific locations and times to pick up pet food. I understand I will not receive food if I show up without an appointment. If I need delivered, I understand I will not receive food until a volunteer can bring it to me. No food will be delivered in inclement weather.*

I understandI disagree with these terms.I need food delivered because of special circumstances.
I agree not to misuse the program. This includes accepting food or items the owner can afford, sharing food/supplies with others, reselling food/supplies, and requesting more than I need.*

I agreeI disagree with these terms.
Is there anything else we need to know? Please share any information we may need to know about you and your pet(s).
I acknowledge that the food and goods I receive are donations provided by The Dog Stays (TDS). I hereby agree to indemnify and hold harmless TDS, including their affiliates, officers, volunteers, donors, and agents (collectively referred to as the “Indemnitees”), from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney’s fees, that may arise as a result of my receipt of food or goods. This includes any potential health issues, such as illness or upset stomach, experienced by my pets from consuming food, treats, or non-edible items. SIGN BELOW ONLY IF YOU AGREE TO THESE TERMS.*
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