DLA Pet Food Pantry Eligibility Enrollment Form

Full Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Number of pets in your household, colony or those you feed outdoors*

Types of pets you have*

DogCatOther

What is your relationship to these pets?

Are your pet spayed or neutered?*

YesNoI have a scheduled appointment for spay/neuter (proof is attached).I need help with finding low-cost or no-cost spay/neuter.

I have provided proof of spay/neuter for each pet I'm enrolling.*

Yes, I have emailed proof of spay/neuter to DelcoLovesAnimals@gmail.com for each pet.If No, please explain below in the Additional Comments section below. I understand Delco Loves Animals can help me find low cost or no cost spay/neuter for my cat(s) or a discount for my dog(s). Once I have an appointment scheduled I will email the proof of the appointment to DelcoLovesAnimals@gmail.com. I understand this will not disqualify me from participating in the pet food pantry and that I will provide proof of spay/neuter within 3 months of being accepted.I am a foster or trapper with a rescue group. The rescue group name, phone number and address is in the Additional Comments or Questions section below.I feed and take care of outdoor cats (including feral/colony cats) that are spayed/neutered and emailed proof to DelcoLovesAnimals@gmail.com.I feed and take care of outdoor cats (including feral/colony cats) that I'm working on getting spayed/neutered. The rescue group name, phone number and address is in the Additional Comments or Questions section below.I feed and take care of outdoor cats (including feral/colony cats) that are either spayed/neutered and/or I'm working on getting spayed/neutered. I do this on my own, pay for it out of my own pocket, not through a rescue. Any additional information I provided in the Additional Comments or Questions section below.

What is your primary reason for seeking assistance?*

I understand that if my pets are not spayed/neutered, I must provide proof of spay/neuter for each of my enrolled pets with 3 months of enrollment.*

Yes

I understand that I must provide proof of my Delaware County, PA residency.*

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 or call: 484-388-9259.*

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 my pet's dietary needs.*

Yes

I understand that I and the authorized adult, identified above, are the only people to whom Delco Loves Animals will provide food for my enrolled pet(s), listed above.*

Yes

I understand that I will be given a Delco Loves Animals Pet Food Pantry identification card that I must present each time I pick up food for my enrolled pet(s) listed above.*

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?*

Additional Comments or Questions

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