Ayres' Petfood Pantry
First name
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Last Name
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Home Phone
Cell Phone
Texts Okay?
No
Yes
What is your preferred method of contact?
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Email
Street Address
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City
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State
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Zipcode
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Current Dogs: Please List Name/Age/Breed/Approx Weight
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Current Cats: Please List Name/Age/Breed/Approx Weight
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Do any of your current pets have medical issues/extra needs.
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No
Yes
Please explain which pet has what extra needs
I agree that any food or resources I obtain from Ayres Memorial Animal Shelter, Inc in Sprakers NY is at my own discretion and I agree to not hold Ayres Memorial Animal Shelter, Inc responsible for any and all injury to my pet(s) who may be utilizing supplies from Ayres Memorial Animal Shelter, Inc.
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Date
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