PET FOOD DISTRIBUTION PROGRAM MISSION The gal f this prgram is t stp the surrender f pets due t the wner s financial inability t prvide care. We particularly want t help lw-incme senirs, the disabled, and veterans wh struggle t feed an aging pet in their care. We aim t prmte respnsible pet care via lw-cst vaccinatins, spays, and neuters. This prgram is designed as a temprary nt permanent slutin t help wners and their belved pets stay tgether during times f financial crisis. It is designed t serve families n a first-cme, first-served basis. Our prgram is perated slely thrugh the genersity and dnatins f gd Samaritans and is nt federally funded. Being dependent n dnatins, we d have t limit the prgram s assistance t a maximum f fur pets per husehld. NOTE: IT IS NOT OUR MISSION t help lw-incme families acquire pets they cannt affrd. It is nt ur missin t supprt persns in acquiring therapy pets. Nr is it ur missin t help peple feed stray, fster care, and utdr cmmunity animals, r Trap-Neuter-Release (TNR) r feral clnies. WHAT THE PROGRAM PROVIDES FREE FOOD DISTRIBUTION Held n select Saturdays frm 9-11 am at the Pet Pantry parking lt. Kibbles are a mixture f dnated fds, s that pets are less likely t react t changes in diet frm mnth t mnth. Plastic buckets must be returned clean and dry. Recipients must prvide their wn transprtatin. http://www.petpantrylc.rg/pet-fddistributins.html DISCOUNTED VACCINATIONS Pets must be up-t-date n rabies vaccinatins. T facilitate cmpliance with state law, rabies and distemper vaccinatins are made available t ur clients: $7.50 each fr cats and dgs. Lw-cst vaccinatin clinics are held peridically at ur facility, That Fish Place, Drake s, Stltzfus Feed & Supply, etc. When scheduled, dates are psted n ur website, in the newsletter, and n ur Facebk page. LOW-COST SPAY OR NEUTER All pets in husehlds n the Pet Pantry Fd Assistance Prgram must be spayed r neutered. (Exceptins with a nte frm the vet.) This is fr the health f yur pet! We understand this may be a financial hardship, s we ffer special reduced rates (listed belw) fr ur clients. We can help make arrangements, and set yu up with an affrdable payment plan if necessary. Call (717)-983-8878 t schedule. Neuter Spay Cat $50 $70 Small Dg (under 40 lbs) $90 (under 35 lbs) $115 Med Dg (41-80 lbs) $105 (36-75 lbs) $140 Large Dg (81-100 lbs) $125 (76-100 lbs) $165 XL Dg (ver 100 lbs) $165 (ver 100 lbs) $205 Rabbit $50 Prices are subject t change withut ntice. Reduced rate rabies, distemper, micrchip, and FIV testing available at time f surgery.
Pet Fd Assistance Applicatin 717-983-8878 PetPantryfLancaster@gmail.cm www.petpantrylc.rg PET PANTRY FOOD PROGRAM ELIGIBILITY REQUIREMENTS We require financial dcumentatin t ensure that ur supprt is ging where it is mst needed. All pets n the Pet Pantry prgram must be ver ne year ld and spayed r neutered. They must als remain up-t-date n all required vaccinatins. It is NOT ur gal t help peple pay fr a new pet which they knew they culd nt affrd. T receive free pet fd and reduced rate spay, neuter, and vaccinatin services, yu must submit an applicatin and all required dcuments, and receive apprval t enter the prgram prir t receiving fd. We limit fd distributin t FOUR pets per husehld, but if yu have mre, all pets will be eligible fr lw-cst vaccinatins and lw-cst spay/neuter services. Once apprved, yu will be eligible fr a perid f ne year frm the date f apprval, prviding yu adhere t all ur guidelines. Nte: all dgs and cats in yur husehld must be registered, and current with rabies shts and spayed r neutered. Pet Pantry can help yu arrange fr lw cst spay/neuter and shts during yur applicatin prcess. REQUIRED DOCUMENTS T qualify fr Pet Pantry s Fd Assistance Prgram, yu must prvide ne f the fllwing demnstrating That yu currently receive at least ne f the fllwing frms r assistance r aid such as: Scial Security Submit letter f benefits Disability Submit letter f benefits Medicaid Submit letter f benefits Unemplyment Submit letter f benefits SNAP Submit letter f benefits r shw us yur ACCESS card TANF Submit current year letter f benefits WIC Submit letter f apprval r prf f current WIC checks OR that yu are experiencing financial hardship such as: Freclsure Submit freclsure statement Lw Incme Status Submit explanatin f current incme alng with supprting dcuments such as cpy f prir year tax return, W2s, etc. Apprval will be n a case-by-case basis. YOU MUST ALSO PROVIDE A valid PA driver s license r ID card shwing that yu reside at a Lancaster Cunty address. Prf f spay r neuter frm a vet. (If pet is nt spayed r neutered, we will require yu t make an appintment fr a reduced-rate spay r neuter, and set up a payment plan.) This must be dne befre receiving fd assistance. Mst recent rabies vaccinatin recrds. If nt up t date, we will require that yu vaccinate yur pet immediately and submit prf f the vaccinatin status with yur applicatin. KEEP THIS PAGE! Mail Cmpleted Applicatin t: Pet Pantry f Lancaster, 26 Millersville Rad, Lancaster, PA 17603 Applicatins missing vet recrds and verificatin f need will nt be cnsidered. Pet Pantry f Lancaster has the right t deny yur applicatin. Yu may als scan and email t petpantryfdprgram@gmail.cm. Make sure yu have given us wrking phne numbers! We may have questins and need t reach yu. If yur applicatin is apprved, we will cntact yu by phne t infrm yu f yur first pick up day. Nte: A pht ID with yur current address may be required at Fd Distributin. 2
Pet Fd Assistance Applicatin 717-983-8878 PetPantryfLancaster@gmail.cm www.petpantrylc.rg APPLICANTS AND PARTICIPANTS MUST AGREE TO THE FOLLOWING GUIDELINES I agree t: Prvide my wn transprtatin t pick up fd nce a mnth. Cntact the Pet Pantry by phne r email if I am unable t pick up fd in any given mnth. Keep all pets n the prgram up-t-date with rabies shts, and prduce written verificatin. Prvide written verificatin f need t the Pet Pantry as requested. Maintain healthy living cnditins fr my pets. Return reusable fd buckets CLEAN and DRY. I agree that I will NOT: Use my pet(s) fr breeding r any illegal activities. Add additinal pets t ur husehld thrugh adptin, purchase, r any ther means, including temprary care and husing. Use Pet Pantry fd t feed stray, fster, feral, r utdr cats. Re-sell r dnate Pet Pantry fd r ther items t any ther persn(s) r rganizatin(s). I agree that I will infrm the Pet Pantry f: Any change in my financial situatin. Any change in my cntact infrmatin, such as address, phne number r email. The death f my pet. I understand that pet supplies are dnated, and the Pet Pantry cannt guarantee the availability f any special fds. I allw Pet Pantry t use phts f me, my family r my pets taken at Fd Distributin. I relinquish all rights fr mnetary gain and cmpensatin frm the use f such phts. I understand and agree that Pet Pantry f Lancaster Cunty makes n warranties as t the pet fd and supplies and des nt assume any liability and/r guarantee fr these pet fd supplies in any way. I take full respnsibility fr any risks invlved in intrducing a different fd fr my pet. By signing this applicatin, I and the members f my husehld and family agree t indemnify Pet Pantry f Lancaster Cunty, Inc., their fficers, directrs, member agents, emplyees, and vlunteers, and hld them harmless frm and against any direct, indirect, special, incidental, punitive, r cnsequential damages, including but nt limited t injury t r lss f my pet, which may arise frm my decisin t accept and use the pet fd. I am aware f the fllwing DISQUALIFICATIONS: If I add additinal pets t my husehld, I will be immediately disqualified, and will n lnger be eligible t receive handuts. If I fail t prduce written verificatin f need and f vaccinatins, I will be remved frm the prgram. If I r my designated stand-in fail t shw up fr tw cnsecutive handuts withut cntacting the Pet Pantry, I will be remved frm the prgram. If I return buckets which have nt been prperly scrubbed and dried, I may be sent hme t clean them. I certify that the infrmatin prvided in this applicatin is true, t the best f my knwledge. I understand that giving false infrmatin will result in denial f the applicatin. Signature Date: 1
Pet Fd Assistance Applicatin 717-983-8878 PetPantryfLancaster@gmail.cm www.petpantrylc.rg Applicatin Date: PART 1: CLIENT INFO FOR PET PANTRY USE ONLY Applicatin cmplete Pht ID Verificatin f Need Spay / Neuter recrds Vaccinatin recrds Status: Cntact Attempts: Name: Number f peple wh live in yur husehld (any age): List ther husehld members (first & last names) and ages. Street Address: City: State: PA Zip: Phne Number 1: 717- Cell Hme Wrk Phne Number 2: Cell Hme Wrk Email: (Email is the mst efficient way fr us t cntact yu!) PART 2: VERIFICATION OF NEED Please attach ne f the fllwing frms f verificatin. Yur applicatin will nt be cnsidered withut it. Scial Security Letter f benefits Disability Letter f benefits Medicaid Letter f benefits Unemplyment Letter f benefits SNAP Letter f benefits r shw us yur ACCESS card TANF Current year letter f benefits WIC Letter f apprval r prf f current WIC checks Freclsure Freclsure statement Lw Incme Submit explanatin f current incme alng with supprting dcuments such as cpy f prir year tax return, W2s, etc. We evaluate each case individually. Yur stry matters. Why d yu need ur help? Please describe yur situatin. Hw did yu hear abut Pet Pantry? 2
Pet Fd Assistance Applicatin 717-983-8878 PetPantryfLancaster@gmail.cm www.petpantrylc.rg PART 3: PET INFO Hw many DOGS are in yur husehld? Hw many CATS are in yur husehld? Nte: We limit fd distributin t 4 pets per husehld, but all pets must be registered and will eligible fr lwcst vaccinatin and spay/neuter services. BREEDING OR SPORT HISTORY Have any f yur pets been used fr breeding? Yes, currently Yes, in the Past Nt sure N Have any f yur pets been used fr sprt? Yes, currently Yes, in the Past Nt sure N If any f yur pets have been used fr breeding r sprt, please indicate this in their infrmatin belw. PLEASE LIST EACH DOG OR CAT WITH THEIR INFORMATION. Nte: Special fd needs must be verified with a nte frm a vet. We cannt guarantee that we will have special fds available, because we distribute what is dnated. PET 1 Dg Cat Name Gender Indr Outdr Breed Apprx Birthdate Apprximate Weight Spay / Neuter Verificatin Attached Nt fixed Vaccinatin Recrds Attached Nt vaccinated Ever used fr Breeding Sprt? Details: Any medical issues r special fd needs? PET 2 Dg Cat Name Gender Indr Outdr Breed Apprx Birthdate Apprximate Weight Spay / Neuter Verificatin Attached Nt fixed Vaccinatin Recrds Attached Nt vaccinated Ever used fr Breeding Sprt? Details: Any medical issues r special fd needs? PET 3 Dg Cat Name Gender Indr Outdr Breed Apprx Birthdate Apprximate Weight Spay / Neuter Verificatin Attached Nt fixed Vaccinatin Recrds Attached Nt vaccinated Ever used fr Breeding Sprt? Details: Any medical issues r special fd needs? PET 4 Dg Cat Name Gender Indr Outdr Breed Apprx Birthdate Apprximate Weight Spay / Neuter Verificatin Attached Nt fixed Vaccinatin Recrds Attached Nt vaccinated Ever used fr Breeding Sprt? Details: Any medical issues r special fd needs? 3
Pet Fd Assistance Applicatin 717-983-8878 PetPantryfLancaster@gmail.cm www.petpantrylc.rg PET 5 Dg Cat Name Gender Indr Outdr Breed Apprx Birthdate Apprximate Weight Spay / Neuter Verificatin Attached Nt fixed Vaccinatin Recrds Attached Nt vaccinated Ever used fr Breeding Sprt? Details: Any medical issues r special fd needs? PET 6 Dg Cat Name Gender Indr Outdr Breed Apprx Birthdate Apprximate Weight Spay / Neuter Verificatin Attached Nt fixed Vaccinatin Recrds Attached Nt vaccinated Ever used fr Breeding Sprt? Details: Any medical issues r special fd needs? PET 7 Dg Cat Name Gender Indr Outdr Breed Apprx Birthdate Apprximate Weight Spay / Neuter Verificatin Attached Nt fixed Vaccinatin Recrds Attached Nt vaccinated Ever used fr Breeding Sprt? Details: Any medical issues r special fd needs? PET 8 Dg Cat Name Gender Indr Outdr Breed Apprx Birthdate Apprximate Weight Spay / Neuter Verificatin Attached Nt fixed Vaccinatin Recrds Attached Nt vaccinated Ever used fr Breeding Sprt? Details: Any medical issues r special fd needs? OTHER PETS If yu have ther pets (such as birds, guinea pigs, rabbits, ferrets, etc.), describe them here. 4