Dog House Assistance Application

The Animal Center accepts dog house donations from the public and gives them to citizens in need.

Name and Contact information

Name*
Date of Birth*
Address*
Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)
Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)
Include your complete e-mail address, including the '@' symbol. (Example: name@example.com)

Household Information

Dependent #1 Name
Dependent #2 Name
Dependent #3 Name
Dependent #4 Name
Dependent #5 Name
Legal Name of Spouse / Parent

Income and Employment Information

$
$
Supplemental income may include food stamps, Medicaid, etc
Are you currently employed?
Is your spouse / partner employed?

Property Information

Do you own your home? *
If you do not own it, do you have permission by the homeowner to build on the property?
NOTE: Written consent from the owner must be submitted.
Is the yard big enough to hold a 150 square foot pen?
Are you applying for materials to reinforce an existing dog house?
Are you applying for materials to build a new dog house?

Pet Information

Dog #1

Dog's Sex
Date the rabies shot was given:
Can you provide a copy of the dog's rabies certificate?*
Is the dog spayed or neutered?*
The dog is / has:
Veterinary clinic address:
Do you have second dog?*

Dog #2

Dog's Sex
Date the rabies shot was given:
Can you provide a copy of the dog's rabies certificate?*
Is the dog spayed or neutered?*
The dog is / has:
Veterinary clinic address:
I can complete the construction within 14 days of receiving the materials and understand that failure to do this can result in citations and fines.*
I can provide vet records, proof of income and a letter from the owner of the property (if appropriate).*
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