Pet Pantry Program

Thank you for your interest in receiving assistance from HSSV’s Pet Pantry Program.

Our goal is to ensure that families who love their pets can continue to care for their pets (these families are defined as “bonded families”). HSSV’s Pet Pantry supports bonded families by providing pet food to pet guardians who cannot afford to feed their pets. Sometimes, pets are surrendered to shelters simply because the guardian has lost their job and can no longer provide the food that the pet needs. The Pet Pantry program exists to ensure that a lack of food won’t cause a bonded family to be broken apart and to decrease stress on the humans who love their pets.

Pet Pantry is available to all bonded family residents of Santa Clara county experiencing financial hardship. Please be advised that we are not able to accept new cat colony clients at this time.

Please fill out the information below to get started.

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First Name *

Last Name *

E-mail address *

Address *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Home Phone Number *

Please enter as (111) 222-3333

Mobile Phone Number

Please enter as (111) 222-3333

Authorized Alternate for food pickup

Food Assistance requested for (please list all):

For your owned pets, please provide the following information: Name, Animal type (dog/cat), age, weight, color, breed. *

I'm unable to pick up my food due to health or transportation issues *

Yes

I would like to have my pet(s) vaccinated at no cost to me: *

Yes

I would like to have my pet(s) altered at no cost to me: *

Yes

How did you hear about the Pet Pantry?

Program Guidelines for Program Participants:

· Please notify the HSSV team in the event that you no longer need support so that others may be helped.

· Food distribution is every 30 days during Pet Pantry designated hours. Shorter exceptions or alternate pick up times may be arranged with prior discussion with HSSV.

· Photo identification will be shown to staff for our records.

· Food will be provided only if HSSV has food to distribute. Support given through this program is dependent on community donations.

· Prescription diet food is not available at this time.

· HSSV cannot guarantee support of additional pets that are acquired after entry into the program.

· Please do not sell, give away, or return to a store any pet food or supplies received through the Pet Pantry.

· HSSV reserves the right to discontinue service through its Pet Pantry program at any time, for any reason.

By electronically signing below, you understand and agree to all of the requirements and statements as indicated in our program outline. Please write your name and the date as your signature.

Signature Name *

Signature Date *

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