Pet Food Assistance Application
This program is for Saginaw County residents experiencing financial hardship.
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
How did you find out about the program?
TO QUALIFY
:
Number of people living in the household?
*
Ages of all the people in the household
Total annual household income (all people in home) ?
*
$0-$10,000
$10,001-$30,000
$30,001-$50,000
$50,001-$75,000
$75,000+
Are you:
*
Unemployed
Part-time employed
Full time employed
On disability
Receive government assistance
Other
Are all your pets in your home spayed or neutered so they cannot reproduce? If not would you like us to help get them fixed?
*
DOGS NEEDING FOOD
How many dogs or puppies are in the home?
What is the breed, age and approximate weight of your first dog?
*
How long have you owned the pet?
*
What is the breed, age and approximate weight of the second dog?
How long have you owned the pet?
*
What is the breed, age and approximate weight of the third dog?
How long have you owned the pet?
*
If additional dogs or puppies in the home please enter a comment below:
What is the brand and/ or type (wet, wet and dry or dry) food that you are currently using?
Do any of the dogs have any medical conditions that may require special food? If so, please explain:
Where do your dogs stay at night?
*
Where does your dogs typically live?
Indoors
Outdoors
Do you need any of the following, if we have available?
collars
leashes
straw for outdoor house
dog house
CATS NEEDING FOOD
How many cats and kittens inside the home?
What are the ages and sex of the adult cats inside the home?
Are all the cats inside the home greater than 4 months of age spayed or neutered?
yes
no
How many cats are you feeding that primarily live outdoors?
1
2-4
5 or more
If you are feeding cats that predominately live outdoors are the spayed or neutered?
I do not know
some are, some are not
none are fixed
all are fixed
What brand and type of food (wet, dry, wet and dry) are you currently feeding your cats?
Are there any of the items listed below that you can also use, if we have available?
litter
food and water bowls for indoors
food and water bowls for the outdoors
straw
outdoor cat houses
Are there any known medical issues that may require special cat food?
Are there any outside cats that are sick or injured that require immediate medical assistance?
yes
no
Are there currently any pregnant or nursing cats?
yes
no
Additional comments:
Submit
Should be Empty: