ResQ Pantry Registration and Request Form

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Personal Information

ResQ Pantry Questionnaire

This form registers you for participation in the ResQ Pantry program. If approved, you will be contacted with information on how we are able to assist you and your pet(s). In emergencies, please contact us at
Please know we are run by volunteers, we apologize for any delays in reply to your requests. We do not intake any animals. 

To The ResQ does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.    

Example: 2 dogs, 4 cats, 1 rabbit
Example: 1) Boots, cat, 2 yrs, 8 lbs 2) Fido, dog, 5 yrs, 35 lbs
Skip to next question for cat colonies.
For example, indicate the colony's location, number of cats, what you are currently feeding, etc.
If you do not have a veterinarian, please write "N/A" in the space below.
Be as specific as possible, for example, Purina One Urinary Tract dry cat food or Pedigree Choice Cuts in Gravy wet dog food.
Please list items below.
For example: cat food (dry- we do not provide wet food), litter (scoopable), flea treatment (dog), etc.
Yes or No

Applicant's Information

Please share as much as possible with us about your current financial situation so that we can make an informed decision on your eligibility. 

IMPORTANT!! Do not skip this step! Please provide a screen shot of a document that shows your participation in any of these programs. Your application will not be processed if you have checked that you receive benefits, but have not provided proof.
Please include information like your current job status (unemployed, employed, retired, student, part-time, disability etc.) or recent change(s) to your income which have led you to need assistance at this time. What income do you have to support your pets? How were you paying for your pets before today, when you are seeking our assistance?
Please explain whether you own or rent your home, are living with family, living in a hotel, are homeless, etc. (This will help us determine whether we will be able to deliver items using internet or store services or have to physically deliver items to your place of residence).

Consent to ResQ Pantry Guidelines and Policies

Please complete this section to agree to our polices and requirements to receive aid. 

For instance, April 24, 1970

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