Emergency Food Bank New Applicant Form

First Name *

Last Name *

Street Number and Street Name *

City *

Postal Code *

Phone Number

Email Address *

Alternate Form of Contact

Number of Dogs in the house *

Number of Cats in the house *

Number of Other Animals in the house *

Pet #1 Name *

Pet #1 Breed *

Pet #1 Age *

Pet #1 Sex *

Pet #1 Size *

Pet #1 Spayed/Neutered *

Pet #2 Name

Pet #2 Breed

Pet #2 Age

Pet #2 Sex

Pet #2 Size

Pet #2 Spayed/Neutered

Pet #3 Name

Pet #3 Breed

Pet #3 Age

Pet #3 Sex

Pet #3 Size

Pet #3 Spayed/Neutered

Pet #4 Name

Pet #4 Breed

Pet #4 Age

Pet #4 Sex

Pet #4 Size

Pet #4 Spayed/Neutered

Total Household Size *

Total Annual Household Income *

What is your age? *

If you did not receive pet food assistance, would you need to surrender your pet(s) to an animal shelter, or otherwise re-home your pet(s)? *

Yes

No

WHS Terms and Conditions

1. Application must be complete, only one person per household may apply.
2. All pet food is provided on an “as available” basis and free of charge. Supplement amount may vary depending on supply on hand.
3. WHS only supplies food for a maximum of four (4) pets total, per household, requests are further limited to ONE request per month.
4. Enrollment is active for one year from date of approval. Pet owners must reapply at that time.  
5. I understand that the goal is to provide supplemental food to animals whose owners are in financial need and is not intended to be the sole source of food for my pets.
6. All pets enrolled in the program must be spayed or neutered. If your pets are not spayed/neutered, the WHS will either attempt to enroll you in our low-cost spay and neuter program OR provide you with a list of options in the surrounding communities. You will need to provide proof that your animal(s) are spayed or neutered within the 8 weeks of enrollment.
7. After enrollment in our Emergency Food Bank program, applicants cannot add to the number of pets in their household. Doing so will disqualify from future assistance.
8. I understand WHS can not be held responsible or liable for any adverse reactions sustained from any food donated to me for my pets.
9. The information I have provided is true and correct. I understand that any false information provided will result in permanent termination from this program.
10. Aggressive and/or disrespectful behaviour is not tolerated and disqualifies the applicant from future assistance.

Guidelines Acceptance