DLA Pet Food Pantry Enrollment Form

DLA Pet Food Pantry Enrollment Form

PLEASE READ THIS THROUGH BEFORE PROCEEDING. DLA's MISSION STATEMENT: To help reduce the stray pet population in Delco through Spay & Neuter and to partner with, support and be a resource for local animal service providers and pet families. IMPORTANT: Please fill out the following information to determine your eligibility for our pet food pantry. All enrollment forms and spay/neuter records must be received by the 15th of the month in order to participate in that month's pantry. Once you complete this form please email spay/neuter records for all pets you're enrolling to DelcoLovesAnimals@gmail.com. All spay and neuter records MUST be legible, and must be in a format that can be printed and they MUST all have the following information on them: Your Name, Your Address, Your Pet's Name and it must state your pet has been spayed or neutered. PLEASE NOTE: We will not review any enrollment forms without the spay/neuter records or records that are not complete. If your pets or strays/ferals that you care for are not spayed/neutered, we will accept a copy of the scheduled spay/neuter appointment. However, once your pet has been spayed or neutered, please forward the records to us at the email above. If you need help finding low or no cost spay/neuter services, please let us know. Please be aware that your pets must be spayed/neutered in order to participate in our Pet Food Pantry. Also, if you have pet cats, they must be indoor cats in order to participate (this doesn't include strays or ferals you may feed outside). Once your application has been reviewed and accepted we will issue you a DLA card which you will need to present along with valid photo ID at each Pet Food Pantry you participate in. Thank you!
I have read DLA's Mission Statement and the IMPORTANT information above. I understand that if my pets are not spayed/neutered, I must have them spayed/neutered within two months of enrolling in the Pet Food Pantry and provide evidence of the appointment before the next Pet Food Pantry, otherwise I will not be eligible to participate. I also agree to inform DLA if I adopt any new pets who live inside my home and also of any new pets outdoors. I will email DelcoLovesAnimals@gmail.com to let them know and I agree to complete a new enrollment form to include the new animals. I understand that DLA will provide the link for the enrollment form once they receive the email from me. Likewise, if any of my pets I care for pass away, I will let DLA know via email.*

I agreeI DO NOT agree
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 Code
Number of pets in your home?*
Number of OUTDOOR cats you feed outside (not including ferals)? Put 0 if none.*
Number of feral cats in the colony you feed/care for outside? Put 0 if none.*
Types of pets you have*

DogCatOther (please explain in Additional Comments section below)
What are the names of your INDOOR PETS that you're enrolling in our Pet Food Pantry? Please specify type of animal (Dog or Cat, etc.) after each name.*
If you have names for the outdoor cats you feed - friendly strays and/or feral cats, please write the names of those you're enrolling in our Pet Food Pantry? If any are not named, please write, "no name" below.*
What is your relationship to these pets? Please check all that appy.*

They are my petsI own a rescue/shelterI'm a fosterI'm a trapperI feed feral or colony catsI feed outdoor straysOther (please explain below under the Additional Comments section)
Are your pets spayed or neutered? This includes dogs, indoor/outdoor/feral/colony cats.*

Yes. I will email spay/neuter records to DelcoLovesAnimals@gmail.com before this month's Pet Food Pantry for all my pets as described above.Yes, however I cannot locate the spay/neuter records and will contact the clinic or veterinarian's office for a copy of the records. I will either have the office send the records directly to DelcoLovesAnimals@gmail.com or I will email them before this month's Pet Food Pantry (we're sorry, but we won't be able to accept records during the Pet Food Pantry).No. I have a scheduled appointment for spay/neuter. I will email proof to DelcoLovesAnimals@gmail.com before the next Pet Food Pantry. And then, after my pet(s) is/are spay/neutered, I will email the records.No. I DO need help finding low-cost or no-cost spay/neuter for my pets. I will email DelcoLovesAnimals@gmail.com to inquire. Once I have an appointment scheduled I will email proof of the appointment to DelcoLovesAnimals@gmail.com. I understand this will not disqualify me from participating in the Pet Food Pantry. I agree to provide proof of the spay/neuter appointment before the next Pet Food Pantry and spay/neuter records within 3 months of being accepted in the Pet Food Pantry program.No. I DO NOT need help finding low-cost or no-cost spay/neuter for my pets. Once I have an appointment scheduled I will email proof of the appointment to DelcoLovesAnimals@gmail.com. I understand this will not disqualify me from participating in the Pet Food Pantry. I agree to provide proof of the spay/neuter appointment before the next Pet Food Pantry and spay/neuter records within 3 months of being accepted in the Pet Food Pantry program.
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?*

Social MediaFriend/FamilyFlyerWebsiteOther
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