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. Outsiders Farm & Sanctuary is proud to serve our local community through outreach programs designed to keep pets and their people together. Our mission extends beyond rescuing animals, it’s about supporting the families who already love them, ensuring pets stay fed, safe, and secure in their homes. This application is for human food, pet food, and pet supply assistance only through our Walt's World Community Assistance program. If you are in need of veterinary care or spay/neuter assistance, please complete our separate Walt’s World Community Clinic Application instead which can be found on our Website www.outsidersfarm.com/waltsworld.
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.
What County do you live in?
What type of Food Pantry Assistance do you need to pick up: select all that apply*

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.
How did you hear about us?

AVITA Community PartnersMeals on WheelsA current participant told me about itOutsiders Farm & Sanctuary instagram/facebook postMy VetOther
Current Vet Name & City
What is your total monthly household income (before taxes)?*

Under $1,000$1000 - $1999$2000 - $2999$3000 - $3999$4000 or more
Are you currently receiving any of the following assistance? (Check all that apply)*

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?*
Do you feed any stray or feral cats?*

YesNo
Are you able to pick up from our location in Bowersville, GA? We may be able to arrange delivery for individuals who are medically homebound, but as a small volunteer-run organization, delivery cannot be guaranteed. Whenever possible, we strongly encourage you to pick up in person or have someone pick up on your behalf.*

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.
May we use photos you provide or that are taken at our community events of you and your pets for our social media, website, grant applications, and outreach materials? If you’re picking up pet food, please provide a clear photo of each pet via Email or Text before your pick up.

YesNoN/A I am not receiving Pet Food Assistance
Please upload photos of your pets you are requesting pet food for here

Cancelof
Are all of your dogs and cats spayed or neutered?*

Yes, all of my dogs and cats are fixed.No, I have dogs and/or cats that are NOT fixed.
If you have dogs and/or cats that are NOT spayed or neutered, are you interested in having them 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.
Did you know Walt’s World is operated by Outsiders Farm & Sanctuary, a 501(c)(3) nonprofit animal sanctuary located in Hart County, Georgia?*

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?