Walt's World Food Pantry-Appointment Request Form

Walt's World Food Pantry-Appointment Request Form

Please fill out this form to request an appointment to pick up a food pantry box. We will review your submission and contact you to confirm the details.
By applying for assistance from Outsiders Farm & Sanctuary’s Pet Food Pantry, you agree to the following:
- All information provided is truthful and accurate
- You are not actively breeding animals
- Your pets are spayed/neutered if age-appropriate
- You are not acquiring new animals while unable to meet current care needs
- You understand that submitting multiple or inconsistent applications may result in denial
Due to limited resources, assistance is not guaranteed. Outsiders Farm & Sanctuary reserves the right to decline any application to ensure fairness and program integrity.

You may reapply if your situation changes or additional clarification can be provided.
Applicant Name*

First NameLast Name
Contact Email Address*
example@example.com
Applicant's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
What County do you live in?*
Cat FoodDog FoodHuman Food
Please Select the Date you can come pick up your Food Pantry Box: Appointments are available MONDAYS and FRIDAYS from 5pm to 7pm. If you are unable to pick up at these times, please arrange for someone else to pick up on your behalf, or contact waltsworld@outsidersfarm.com after completing this entire application and see if we can arrange an additional time for you.
AVITA Community PartnersMeals on WheelsA current participant told me about itOutsiders Farm & Sanctuary instagram/facebook postMy VetOther
Current Vet Name & City
Under $1,000$1000 - $1999$2000 - $2999$3000 - $3999$4000 or more
SNAP (Food Stamps)Medicaid/MedicareDisability (SSI/SSDI)Unemployment BenefitsHousing AssistanceNoneOther
How many people live in your household?*
How many cats are in your household?*
How many dogs are in your household?*
YesNo
Yes, I have transportation or someone to pick up on my behalf.No, I do not have transportation or anyone to pick up on my behalf.
YesNoN/A I am not receiving Pet Food Assistance
Please upload photos of your pets you are requesting pet food for here*

Cancelof
Yes, all of my dogs and cats are fixed.No, I have dogs and/or cats that are NOT fixed.
Yes, please provide me information on the Walt's World Low Cost Voucher Program.Yes, but I cannot afford to have them fixedNo, I do not want to fix my pets so I can breed them.No, I do not want to fix my pets because I do not agree with it.This doesn't apply to me. All of my dogs and cats are fixed
Please list each of your pets’ name, age, breed, and spay/neuter status. Example: Bella – Chihuahua, 4 years old, spayed or Domino – Shorthair cat, 2 years old, not fixed. We don’t discriminate based on size, age, or spay/neuter status, this information simply helps us connect you with the right resources!*
If you selected Human Food Assistance, please explain below how many people are in your household with their ages and any food allergies.
YesI had no idea
How You Can Help Us Continue:

A compassionate community is one where neighbors support one another. We do our best to help our neighbors in need and even if you can’t contribute financially or volunteer in person, your support still means the world to us. Outsiders Farm & Sanctuary is home to over 400 rescued animals, most once abandoned, abused, or neglected, now living safely in sanctuary. Our residents include pigs, goats, cows, chickens, ducks, dogs, cats, rabbits, and guinea pigs, all receiving lifelong care and love. We’re always looking to grow our community of supporters and volunteers! Even if you can’t physically volunteer, you can make a huge impact by helping us spread the word online. Follow our sanctuary page at www.facebook.com/outsidersfarmandsanctuary and help us for FREE by liking, commenting, and sharing our posts regularly. Every interaction helps us reach more people, rescue more animals, and support more families in need. 💚
What's Next?

Sign and submit your application below, and it will be sent to be reviewed by our volunteer team. Please be patient.

If approved, you will receive an email with directions on how to pick up your food box.

If approved, Please arrange to pick up your food between 5pm and 7pm on the date you selected. If you cannot make that time, you MUST LET US KNOW before 5pm that day. We cannot leave food out over night. We are a small, volunteer-run organization that also operates a sanctuary for over 400 rescued animals. Walk-in or drop-in requests for assistance cannot be accommodated.
Signature Name- By completing this application, I am confirming that I understand this program is for individuals and families experiencing financial hardship. I agree to request and receive assistance only for my household and will not sell, give away, or trade any food or supplies provided. If I receive an item I cannot use, I will return it unopened to Walt's World at Outsiders Farm & Sanctuary so it can help another family in need.

First NameLast Name
Should be Empty:

Walt's World Food Pantry-Appointment Request Form

How You Can Help Us Continue:

What's Next?