Tri-County Pet Pantry Request Form

Second Chance Humane Society’s mission is Connecting Pets, People & Communities While Saving Lives. We believe pets and people live better together and are committed to keeping pets together with their families. This Tri-County Pet Pantry has been established with that goal and serves residents of Ouray, Montrose & San Miguel Counties.

Your Name(*)

Please let us know your name.

Your Email(*)

Please let us know your email address.

Phone(*)

Provide us your phone number please

Street Address(*)

Add your street address please

City(*)

Please provide your city

Zip Code(*)

Add your zip code please

Are you currently experiencing:

Income and/or Job Loss Due to COVID-19(*)

Yes

Unemployment not related to COVID-19(*)

Yes

Senior, unable to leave home(*)

Yes

Homelessness(*)

Yes

Gross Income below $40,000(*)

Yes

Do you live in Ouray, San Miguel, or Montrose County(*)

Yes

This program is currently available to low-income residents of Ouray, Montrose and San Miguel Counties that meet the criteria above. If you do not meet one of these criteria, please call us 970.626.2273 to discuss other possible solutions.

Are you able to pick up your supplies?(*)

Yes

Let us konw about those supplies!

If not, please let us know where we should leave your food/supplies?

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How many dogs to you have?

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How many cats do you have?

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Average weight of your dogs

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Do your pets require any special food or have allergies?

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If requesting canned food please indicate the reason (canned food is limited so please limit requests to pets with health / dental issues that render them unable to eat kibble).

Are you interested in information about low cost Spay/Neuter (when resumed) or our low cost vaccination/micro-chip program (available now):

Yes

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Please answer the following (answers do not prohibit you from qualifying for food/supplies):

Are all pets current on vaccinations: (*)

Yes

Need to know if your pets are vaccinated

Are all pets Micro-chipped: (*)

Yes

Need to know if your pets are micro-chipped

Are all pets Spay/Neutered:(*)

Yes

Are your pets all spayed or neutered

Are there any other resources that you need at this time (leashes, collars, dog bed, cat blankets, cat litter, training tips, pet health concerns etc.)?

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How did you hear about this program?

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Second Chance Tri-County Pet Pantry Agreement

I understand that the pet food and supplies received through Second Chance Humane Society has been donated by manufacturers and individuals and is not for sale or barter 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.

There is no guarantee that food will be available through the Second Chance Tri-County Pet Pantry at any given time and recipient is encouraged to research additional sources for pet food and resources.

I understand and agree that Second Chance makes no warranties as to the availability, quality, or quantities, of the (title) pet food and supplies and does not assume any liability and/or guarantee for these pet food supplies in any way.

In signing this I agree to allow Second Chance to contact me via email for upcoming clinics and additional services.

All food is donated and delivered either by staff or volunteers. We suggest a $5.00 donation, or what you feel you can afford, to pay it forward or help cover for delivery cost.

Recipient Printed Name

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(*)

Sign Above

We need that signature

(*)

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