Food Bowl Recipient Application


Published on

If you or someone you know is in need of assistance via The Food Bowl program, please use this form to apply for help.

Published in: Lifestyle, Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Food Bowl Recipient Application

  1. 1. Food Bowl Recipient ApplicationPlease complete this application for pet food assistance from the Athens Area Humane Society’s Food Bowl,and please be truthful and honest in your answers. False information will result in disqualification from theprogram.In order to qualify for assistance, all applicants must: Be age 18 or older. Not be a dependent of a parent or guardian. Present a photo ID with a current address. Present proof of government assistance or a combined household income of $20,000 or less. Provide accurate and truthful information about the applicant and pets in the household. Understand that the pet food brands provided may not match your current food; therefore, your pet(s) may experience some initial stomach upset due to the change in diet. (Mixing your current food with the new food over the course of a few days should decrease your pet’s likelihood of stomach upsets.) Agree to spay or neuter your pet(s) within 6 months if they are unaltered, and provide up-to-date rabies vaccinations to your pet(s) within the next 3 months if they are overdue for vaccines. AAHS provides low-cost, high-quality spays and neuters at their Athens Regional Spay Neuter Center. Low- cost vaccines are available at the time of spay and neuter or during the monthly AAHS Pet Care Clinics on the first Saturday of every month (excluding September and November). Understand that pet food assistance is intended to be a temporary solution for individuals and families during times of hardship.Requests for specific food types (kitten, senior, large breed, etc.) will be granted if the food is available.Brand of food preferred for pets:I have read the above qualifications, and I understand and agree to all of the above provisions.Signature: Date:
  2. 2. Food Bowl Recipient ApplicationPlease complete all boxes.Name: Date:Address:City: State: Zip:Phone: E-mail:# Household Members: # Pets in Household:Have you previously received assistance from the AAHS Food Bowl? Yes NoReason for need for pet food assistance: Proof of need for assistance provided:Are you a dependent? Yes NoHow did you hear about the AAHS Food Bowl?Complete boxes for up to two pets who will receive pet food.Pet Name: Type: Cat Dog Spayed/Neutered? Yes NoBreed: Age: Size: S M L XLPet Name: Type: Cat Dog Spayed/Neutered? Yes NoBreed: Age: Size: S M L XLI certify that the information provided in this application is true and that providing any false information will result inthe disapproval of this application and future disqualification from the program.Signature: Date: