DLA Pet Food Pantry Eligibility Enrollment Form

DLA Pet Food Pantry Enrollment Form For Rescues, Shelters, and Clinics

Please fill out the following information to enroll in our Pet Food Pantry. Once we receive and review your application, we will be in touch. Thank you.
Name of Rescue & Name of Authorized Contact Person*

Name of RescueName of Authorized Contact Person
Name(s) of Those Authorized to Pick Up Pet Food & Supplies
Email Address of Authorized Contact Person*
example@example.com
Phone Number of Rescue or Authorized Contact Person*
Please enter a valid phone number.
Address of Rescue (if no physical location please put a period in each box)*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What services do you provide? Please check off all that apply:

TNR ProgramFoster ProgramTake in Surrendered PetsFeed Feral ColoniesFeed Outdoor CatsOther - Please specify in the "Additional Comments or Questions" section below.
Type(s) of animals you rescue and/or trap:

Cats (including feral)DogsRabbitsGuinea Pigs/HamtersOther - Please specify in the "Additional Comments or Questions" section below
Would your organization be willing to discuss how your organization and Delco Loves Animals can collaborate?*

YesNoOther - Please explain in the "Additional Comments or Questions" section below
I understand that I must provide proof that my organization is in Delaware County, PA.*

Yes
I understand that I may receive food for each of my pets only once per calendar month and that it is my responsibility to pick up food at one of the Pet Food Pantry's designated dates and times. I will not receive food outside of set dates and times. For the most current locations, dates, times and inclement related updates I should check the Delco Loves Animals Facebook page.*

Yes
I understand that the pet food I receive is meant to be supplementary and will not cover an entire month's worth of food or be specific to a pet's dietary needs.*

Yes
I am authorized by said organization (see above) to complete this form and I understand that anyone from my organization who comes to the Pet Food Pantry must be listed on this form and show identification before receiving any goods from the Pet Food Pantry.*

Yes
I understand that I Delco Loves Animals reserves the rights to refuse service to me.*

Yes
I understand that I Delco Loves Animals reserves the right to revise, change and/or assign additional conditions to enrollment in the Delco Loves Animals Pet Food Pantry without notice.*

Yes
How did you hear about our Pet Food Pantry?*

Social MediaFriend/FamilyFlyerWebsiteOther
Additional Comments or Questions
Signature

Clear
Should be Empty:

DLA Pet Food Pantry Enrollment Form For Rescues, Shelters, and Clinics