NEGAS Pet Pantry Request

Thank you for reaching out to the NEGAS Pet Food Pantry. We understand that times are difficult, and our goal is to keep as many pets with their families as possible. With that in mind, please understand that this program is not set up to supply food permanently, and is for temporary assistance only. With approval of your application, we will provide food for up to a 3-month period, at which time reapplication may be required. This program is open to Franklin and Hart County, Georgia residents only.

To be considered for assistance, applicants must:

• Be the owner of the animal(s) and be over 18 years of age.
• Provide proof of valid government ID showing residence in Franklin or Hart County, GA
• Understand that we must limit the number of pets that are given food to two per household.
• Understand that specific types of food will be considered (senior, grain-free, puppy, etc) but that our Food Pantry is only able to provide what is available from donated supplies, and resources are limited. You are at will to refuse food offerend without terminating the application of assistance, but may not be able to have specific requests accommodated.
• Understand that the NEGAS Pet Food Pantry reserves the right to deny or terminate assistance at our discretion

Name - First *
Name - Last *
Address *
City *
State *
ZIP *
Cell Phone *
Email *
Number of Pets *	1 2
First Pet:
Name *
Species *	Cat Dog
Sex *	Male Female
Age * (in years)
Weight * (approximate, in pounds)
Second Pet:
Name *
Species *	Cat Dog
Sex *	Male Female
Age * (in years)
Weight * (approximate, in pounds)
Please review and acknowledge these program guidelines
I understand thay there may only be one account per household. *	NoYes
I understand that I will only receive assistance for up to 3 months, after which I may have to reapply. *	NoYes
I may only pick up food once a month or every four weeks. *	NoYes
I understand that spaying or neutering my animal helps prevent unwanted litters, helps protect against some serrious health problems, and may redue many of the behavioral problems associated with the mating instinct. *	NoYes
I understand that NEGAS can provide me with resources regarding sterilization if I am interested in additional information. *	NoYes
I understand that my pet(s) should not be used for breeding purposes or illegal acts. *	NoYes
Signature * (sign with your fingertip or mouse)	Clear