Please fill out this form for every individual pet for which you are asking for assistance.
* indicates required field
Name (First & Last Name): * Address: * City: * State: * Zip Code: * Email: * Phone Number: * Who is your employer? * Government benefits receiving: * How many pets are currently in your household? (If none, leave as 0) * Dogs: Cats: Others - (Please specify): Have you ever used our Kibble Kitchen services before? * —Please choose an option—Yes - I have used the program beforeNo - this is my first time Pet Name: * Pet Breed: * Pet Weight: * Pet Age: * Pet Primary Color: * Is your pet spayed/neutered? * YESNO Where was your pet spayed/neutered? * Is your pet current on rabies vaccinations? * YESNO Medical Concerns: * What items are you requesting for your pet(s)? * Dry Dog FoodDry Puppy FoodWet Dog FoodWet Puppy FoodDog TreatsDry Cat FoodDry Kitten FoodWet Cat FoodWet Kitten FoodCat LitterOther If you selected OTHER, please describe: Do you need assistance with low-cost spay/neuter or vaccination services? * YESNO Do you have transportation? * YESNO What is your preferred appointment time? * 9 - 9:30 AM9:30 - 10 AM10 - 10:30 AM10:30 - 11 AM11 - 11:30 AM11:30 - 12 PM12 - 12:30 PM12:30 - 1 PM1 - 1:30 PM1:30 - 2 PM Reason(s) for needing assistance from our Kibble Kitchen: * Is there any additional information you would like us to know? How did you hear about the Kibble Kitchen? * WebsiteFacebookInstagramFrom a friend/family memberE-mail ListSpecial EventOther If you selected OTHER, please specify: * Please check that you have read and understand the following guidelines of our Kibble Kitchen Program: Applicants must be at least 18 years old. Supplies are dependent upon what is donated. All items must be picked up within 48 hours of email/phone confirmation that supplies are ready. All cats and dogs must be spayed or neutered and proof is required. You may request supplies once a month as needed, but by accepting assistance you are agreeing NOT to acquire additional animals while receiving assistance from The Heritage Humane Society's Kibble Kitchen Program. This program is designed to assist people experiencing a temporary financial need, not a lifetime program. Proof of government or community assistance is required. Proof of identification is required. Your pet's name, age, breed, special needs, and number of animals in the house must be provided. You may have a friend or family member pick up as long as it has been prearranged. By receiving pet food or supplies and/or flea/tick treatments from HHS you accept all responsibility and liability for the use of these products. You further agree to hold harmless The Heritage Humane Society for any supplies that you receive. By accepting supplies, you understand that assistance to help during economic crisis is not an ongoing monthly distribution program. I have read and understand the guidelines
