Companion Animal Assistance Program Guidelines (CAAP) Companion Animal Assistance Program Guidelines (CAAP)

Thank you for your interest in the Food Share Program. The goal of the program is to provide free Thank you for your interest in the Pet Food Share Program. The goal of the program is to provide free dog and food to pet owners during their time of need. The Humane Society of Sheboygan County (The and to pet owners during their time of need. The Humane Society of Sheboygan County (The Humane Society) and Sheboygan County Food Bank (SCFB) have partnered to provide free food in one (1) Humane Society) and Sheboygan County Food Bank (SCFB) have partnered to provide free food in one (1) year increments. Please review the program guidelines below. year increments. Please review the program guidelines below.

 All participants will need to complete the attached application and submit at their local pantry.  All participants will need to complete the attached application and submit at their local pantry.  Sign-up is available ONLY at food pantry locations during pantry hours, NOT at The Humane  Sign-up is available ONLY at food pantry locations during pantry hours, NOT at The Humane Society or SCFB. Society or SCFB.  To qualify for 1-2 free bag(s) of food you must be an active participant at a qualified local food  To qualify for 1-2 free bag(s) of food you must be an active participant at a qualified local food pantry (1 program participant per household). If multiple citizens registered per address only one pantry (1 program participant per household). If multiple citizens registered per address only one application will be honored. application will be honored.  Household can ONLY register at ONE pantry; if registered at multiple pantries household will be  Household can ONLY register at ONE pantry; if registered at multiple pantries household will be removed from CAAP. removed from CCAP.  Participation is on first come basis and availability of food.  Participation is on first come basis and availability of food.  Participants will be active for one (1) year, and then must sign-up again if additional help is  Participants will be active for one (1) year, and then must sign-up again if additional help is needed. needed.  Specialty food will not be supplied. Canned food only available for special circumstances if  Specialty food will not be supplied. Canned food only available for special circumstances if available, we cannot meet brand specific requirements. available, we cannot meet brand specific requirements.  The Humane Society cannot guarantee consistent type or brand of food each month.  The Humane Society cannot guarantee consistent type or brand of food each month.  The program is designated for indoor animal use ONLY.  The program is designated for indoor animal use ONLY.  Participants are not allowed to add additional animals to the program once they are enrolled. If  Participants are not allowed to add additional animals to the program once they are enrolled. If you are thinking of adopting or acquiring a new pet that will need assistance, additions can only you are thinking of adopting or acquiring a new pet that will need assistance, additions can only be added during the renewal period. be added during the renewal period.  Participants cannot have an excessive number of animals, as The Humane Society can only supply  Participants cannot have an excessive number of animals, as The Humane Society can only supply food for a reasonable amount per household. food for a reasonable amount per household.  Participants will not be eligible for renewal if their animals are not altered. Must provide  Participants will not be eligible for renewal if their animals are not altered. Must provide spay/neuter certificate during your first visit or once available within your first year. ** The spay/neuter certificate during your first visit or once available within your first year. ** The Humane Society can help sterilize your pet(s) through SNAP (Spay-Neuter-Assistance-Program) a Humane Society can help sterilize your pet(s) through SNAP (Spay-Neuter-Assistance-Program) a discounted service; funds may be available to offset costs. A separate SNAP application MUST be discounted service; funds may be available to offset costs. A separate SNAP application MUST be submitted.** submitted.**  The Humane Society reserves the right to deny eligibility at any time.  The Humane Society reserves the right to deny eligibility at any time.  If you breed or intend to breed you are NOT eligible for the program.  If you breed or intend to breed you are NOT eligible for the program.  Pick-up: Food will be available for pick-up at the Humane Society of Sheboygan County during  Pick-up: Food will be available for pick-up at the Humane Society of Sheboygan County during regular schedule business hours (Monday-Friday 12-6PM and Saturday 12-4PM). Pick-up is NOT regular schedule business hours (Monday-Friday 12-6PM and Saturday 12-4PM). Pick-up is NOT available outside of scheduled hours (NO acceptations). available outside of scheduled hours (NO acceptations).  Inspect all food for impurities. If impurities are found throw the food away-do not feed  Inspect all food for impurities. If impurities are found throw the food away-do not feed contaminated food to your pet(s). contaminated food to your pet(s).  The Humane Society reserves the right to discontinue the program/services at any time.  The Humane Society reserves the right to discontinue the program/services at any time.

See reverse side for application See reverse side for application

Revised 11/2018

Office Use Only: Approved or Denied Date: ______Office Use Only: Approved or Denied Date: ______

Companion Animal Assistance Program (CAAP) Application Companion Animal Assistance Program (CAAP) Application

Print clearly and legibly or your application will not be accepted Print clearly and legibly or your application will not be accepted Print First & Last Name Date Phone Print First & Last Name Date Phone

Address: Street Apt City State Zip Address: Street Apt City State Zip

Email Pantry Name/Location Email Pantry Name/Location

Pet List – Tell us about the pet(s) in your household that need assistance. Pet List – Tell us about the pet(s) in your household that need assistance. Spayed or Spayed or Type of Animal Type of Animal Pet’s Name Neutered Pet’s Name Neutered (circle or X) (circle or X) (circle or X) (circle or X) 1 Large Dog Small Dog Puppy Cat Yes No 1 Large Dog Small Dog Puppy Cat Kitten Yes No 2 Large Dog Small Dog Puppy Cat Kitten Yes No 2 Large Dog Small Dog Puppy Cat Kitten Yes No 3 Large Dog Small Dog Puppy Cat Kitten Yes No 3 Large Dog Small Dog Puppy Cat Kitten Yes No 4 Large Dog Small Dog Puppy Cat Kitten Yes No 4 Large Dog Small Dog Puppy Cat Kitten Yes No 5 Large Dog Small Dog Puppy Cat Kitten Yes No 5 Large Dog Small Dog Puppy Cat Kitten Yes No Comments/ Dietary Restrictions: Comments/ Dietary Restrictions:

If spayed/neutered please provide certificate for each pet on your first pick-up visit. If not spayed/neutered, If spayed/neutered please provide certificate for each pet on your first pick-up visit. If not spayed/neutered, please describe reason: ______please describe reason: ______

**The Humane Society of Sheboygan County can help you sterilize your pet(s) through SNAP (Spay-Neuter- **The Humane Society of Sheboygan County can help you sterilize your pet(s) through SNAP (Spay-Neuter- Assistance-Program) at a discounted rate. A separate SNAP Application MUST be submitted and can be found Assistance-Program) at a discounted rate. A separate SNAP Application MUST be submitted and can be found at https://adoptsheboygancounty.org/learn/programs-services/).** at https://adoptsheboygancounty.org/learn/programs-services/).**

□ Once approved all information and approval will be sent electronically via email. If you will need □ Once approved all information and approval will be sent electronically via email. If you will need communication sent via direct mail, please check this box. communication sent via direct mail, please check this box.

Signature: ______Date:______Signature: ______Date:______

If you have any questions or concerns please contact The Humane Society at 920-458-2012. Please submit If you have any questions or concerns please contact The Humane Society at 920-458-2012. Please submit your completed application to your local food pantry location. your completed application to your local food pantry location.

*** For those participants that are financially able, we appreciate any donation you are able to give to help *** For those participants that are financially able, we appreciate any donation you are able to give to help offset the cost of pet food. *** offset the cost of pet food. *** Revised 11/2018

Office Use Only: Approved or Denied Date: ______Office Use Only: Approved or Denied Date: ______