Food Bowl Recipient Application

Please complete this application for pet food assistance from the Athens Area Humane Society’s Food Bowl,

and please be truthful and honest in your answers. False information will result in disqualification from the

program.

In order to qualify for assistance, all applicants must:

Be age 18 or older.

Not be a dependent of a parent or guardian.

Present a photo ID with a current address.

Present proof of government assistance or a combined household income of $20,000 or less.

Provide accurate and truthful information about the applicant and pets in the household.

Understand that the pet food brands provided may not match your current food; therefore, your pet(s)

may experience some initial stomach upset due to the change in diet. (Mixing your current food with

the new food over the course of a few days should decrease your pet’s likelihood of stomach upsets.)

Agree to spay or neuter your pet(s) within 6 months if they are unaltered, and provide up-to-date

rabies vaccinations to your pet(s) within the next 3 months if they are overdue for vaccines. AAHS

provides low-cost, high-quality spays and neuters at their Athens Regional Spay Neuter Center. Low-

cost vaccines are available at the time of spay and neuter or during the monthly AAHS Pet Care Clinics

on the first Saturday of every month (excluding September and November).

Understand that pet food assistance is intended to be a temporary solution for individuals and families

during times of hardship.

Requests for specific food types (kitten, senior, large breed, etc.) will be granted if the food is available.

Brand of food preferred for pets:

I have read the above qualifications, and I understand and agree to all of the above provisions.

Signature: Date:

Food Bowl Recipient Application

Please complete all boxes.

Name: Date:

Address:

City: State: Zip:

Phone: E-mail:

# Household Members: # Pets in Household:

Have you previously received assistance from the AAHS Food Bowl? Yes No

Reason for need for pet food assistance:

Are you a dependent? Yes No Proof of need for assistance provided:

How did you hear about the AAHS Food Bowl?

Complete boxes for up to two pets who will receive pet food.

Pet Name: Type: Cat Dog Spayed/Neutered? Yes No

Breed: Age: Size: S M L XL

Pet Name: Type: Cat Dog Spayed/Neutered? Yes No

Breed: Age: Size: S M L XL

I certify that the information provided in this application is true and that providing any false information will result in

the disapproval of this application and future disqualification from the program.

Signature: Date: