Pet Food Assistance Request Form

In order to fulfill our mission of providing care to animals in need and services to all pet owners in the community, Animal Protection Society of Durham has been gathering pet food to assist those facing financial hardship at this time. Please complete this form if you are in need of assistance with providing food for your pet due to loss of income from the COVID-19 crisis.

Please note, you must live in Durham County and your application does not guarantee assistance. Pet food will be distributed to Durham County residents as available.

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* 1. Your name:

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* 2. Please provide the best contact info for you, including home address and at least one form of contact (email or phone number).

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Why are you seeking pet food assistance at this time?

I am unemployed as a result of COVID-19 and state/local restrictions.

I am underemployed (hours/pay have been reduced) as a result of COVID-19 and state/local restrictions .

Other

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* 4. If you selected "Other" in question 3, please explain

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* 5. How many pets do you own and what is their species? If you have both dogs and cats, please select both.

1 Dog

2 Dogs

3 Dogs

4 or more Dogs

1 Cat

2 Cats

3 Cats

4 or more Cats

Other

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* 6. If you chose "Other" in Q5, please explain.

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* 7. Type of assistance needed. Check all that apply.

Small dog food (under 20 pounds)

Medium Dog food (20-50 pounds)

Large dog food (over 50 pounds)

Cat food

Cat litter

Pet Food Assistance Request Form

Question Title

* 1. Your name:

Question Title

* 2. Please provide the best contact info for you, including home address and at least one form of contact (email or phone number).

Question Title

* 3. Why are you seeking pet food assistance at this time?

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* 4. If you selected "Other" in question 3, please explain

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* 5. How many pets do you own and what is their species? If you have both dogs and cats, please select both.

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* 6. If you chose "Other" in Q5, please explain.

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* 7. Type of assistance needed. Check all that apply.

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* 8. Does your pet(s) have any dietary restrictions (i.e. allergies) or preferred food (i.e. wet or dry)? If so, please describe.

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* 9. What day of the week and time would you be available to pick up pet food from the shelter?