Pet Food Pantry Request Form for Existing Clients

Submit an Application

"*" indicates required fields

Have you ordered from the pantry before?*

Yes

If you are new to the pantry, please apply here instead. Thank you!

General Information

Name*

First Last

Email*

Phone*

Has your address changed since your last delivery?*

Yes

Please update your address below.*

Street Address Address Line 2 City State ZIP Code

Have there been any changes in the number/types of household pets since your last delivery?*

Yes

Pet 1

Is your pet a dog or a cat?*

Dog

Cat

Is your pet altered?*

Yes

Pet Name*

Pet Breed*

Pet Age*

Pet Weight*

Do you have an additional pet to add/edit?*

Yes

Pet 2

Is your pet a dog or a cat?*

Dog

Cat

Is your pet altered?*

Yes

Pet Name*

Pet Breed*

Pet Age*

Pet Weight*

Do you have an additional pet to add/edit?*

Yes

Pet 3

Is your pet a dog or a cat?*

Dog

Cat

Is your pet altered?*

Yes

Pet Name*

Pet Breed*

Pet Age*

Pet Weight*

Do you have an additional pet to add/edit?*

Yes

Please list changes for and/or add any additional pet(s).*

For each pet, please list if your pet is a dog or a cat, whether or not they are altered, and their name, breed, age, and weight.

Pick Up Information

Pickup Date*

Will someone be picking up for you?*

Yes

If someone is picking up for you, what is the person's first and last name?*

Please initial below.*

I recognize that in receiving assistance in the form of donated pet food there exists risk of injury or sickness, including personal injury or harm to me, my pet(s) and others. On behalf of myself, my heirs, personal representatives and executors, I hereby release, discharge, indemnify, and hold harmless Friends of the Cuyahoga County Animal Shelter, and its agents from any and all claims, causes of actions of demands, of any nature or cause connected with my receipt of assistance in any form from Friends of the Cuyahoga County Animal Shelter.

Please initial below.*

I understand that 1) Friends of the Cuyahoga County Animal Shelter has a limited amount of food available for animals in need; 2) the amount of food provided will be determined on a case by case basis, depending on availability and need; 3) a representative will establish date(s) and time(s) for me to receive the allocated food; 4) based on demand, I will only receive a limited amount of food each month, and FCCAS cannot guarantee how much or how often it can provide food to me for the animals in my care; 5) FCCAS reserves the right to request proof of assistance needed for my request.

Please initial below.*

I understand that this is a voluntary service and by making my request I am committing to picking up my order at the time selected above. Should I fail to meet my commitment pick up time, FCCAS may remove me from the program at will.

Applicant Signature*

Application Date*

MM slash DD slash YYYY

Comments

This field is for validation purposes and should be left unchanged.

Contact

Email: help@fccas.org

Phone: 216-706-9363

Mail: P.O. Box 25684
Garfield Heights, OH 44125

Social

"*" indicates required fields

Email*

Name

This field is for validation purposes and should be left unchanged.

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