Emergency Pet Food Pantry Request

The pet food pantry is available to Montgomery County residents only and will serve to assist pet owners during financial hardships.

The pantry will review and approve pet food requests Monday through Friday between 11:00 a.m. – 4:00 p.m. Once approved, you will be notified to pick up at the Montgomery County Animal Care and Adoption Center. If a request is submitted on a Friday, it could be available for pick up on Saturday, however requests will not be reviewed/approved on Saturday and Sunday.

• Participants are limited to 1 visit each month
• Maximum amount of food per visit is 50 lbs.
• A photo ID is required to show proof of residency
• All requests are subject to availability

Our community’s health is a priority to us, so social distancing guidelines will be enforced. A staff member will work with you in advance to schedule a date/time for pickup. If you are showing signs of illness, please stay home.

APPLICANT INFORMATION
First Name * First Name
Last Name * Last Name
Street Address * Street Address
City * City
Zip Code * Zip Code
Preferred contact method? *	Phone Email
Phone Number Phone Number
Email Address Email Address
PET INFORMATION Please provide information below for each pet in the home. Special dietary needs will be considered if food is available (i.e. senior, puppy, etc.).
Pet Name
Pet Species	Cat Dog
Pet Approx. Weight
Pet Approx. Age
Pet Name
Pet Species	Cat Dog
Pet Approx. Weight
Pet Approx. Age
Pet Name
Pet Species	Cat Dog
Pet Approx. Weight
Pet Approx. Age
Pet Name
Pet Species	Cat Dog
Pet Appox. Weight
Pet Approx. Age
Are all of your pets spayed/neutered?	NoYes
Would you like to be contacted about assistance for spaying/neutering your pets?	NoYes
Comments Comment
ACKNOWLEDGEMENT
I understand that the pet food and supplies received through the Montgomery County Emergency Pet Food Pantry has been donated by manufacturers and individuals and is not for sale to the public. Therefore, I agree to use these products for my personal pet(s) only and will not re-sell these products to any person(s) or business(es). I understand and agree that Montgomery County Emergency Pet Food Pantry makes no warranties as to the pet food and supplies and does not assume any liability and/or guarantee for these pet food supplies in any way. I certify that the information provided in this application is true, to the best of my knowledge. I certify that I am a Montgomery County resident and I understand that giving false information may result in denial of the application. *
Date * Date
Signature * Signature	Clear