Bountiful Bowl Community Partner Application

HSHV’s Bountiful Bowls program partners with other organizations within Washtenaw County to ensure all members of the family are receiving assistance in trying times. With a little assistance, a pet owner can often find a way to keep their pet in their home and HSHV is here to help!

Because resources are limited, the Bountiful Bowls program should supplement your monthly supply of pet food and not be the sole source of food for pets. You should expect to purchase food for your pets in addition to receiving the program food to meet their full nutritional needs.

Membership Terms

Applicants for this application must be working with Avalon Housing, YMOW, AAMOW or Manchester Family Services.
Monthly food pick will be distributed by the organization you are receiving services from.
Food for the program is donated to HSHV by the generosity of our community partners; therefore, we cannot guarantee that food is always available.
The recipient cannot acquire more animals while participating in this program and will not be allowed to adopt from HSHV. Food will be provided for up to 5 animals.
This program is intended to provide temporary, supplemental assistance for up to six months, initially.
All animals in the household should be spayed or neutered. HSHV can assist with low cost or free services, as needed.

Please complete the application below.

Bountiful Bowls Community Partner Application

First Name *

Last Name *

Phone (MUST be current) *

Additional Phone

Email (must be valid for approval document) *

Please select which community organization you are receiving support from.

In which Avalon Housing building do you reside? In which Avalon Housing building do you reside?

Household Members

Please list other people living in your home, including their full name and relationship to you.

Name of household member

What is your relationship with this person?

Add another household member Remove this household member

Your Companion Animals

Name of pet *

Type of pet *

Dog

Cat

Breed of pet

Sex of pet *

Approximate age of pet *

Approximate weight in pounds (lbs.) *

Fixed? *

Indoor? *

Add another pet Remove this pet

Please note: Our program requires that all cats and dogs in your home are spayed/neutered and proof of this will be required. If they are not, HSHV can assist with low cost or free spay/neuter surgeries. Do you need support in getting your animals spayed/neutered?

**For cat owners only: At times, we have may have cat litter available for distribution. If we do have some to distribute, would you like to receive cat litter?

Has your pet seen a vet in the last 2 years?

Yes

Your Veterinarian

Your Veterinarian's Name (If applicable)

Your Veterinarian's Phone Number

I understand that all dogs and cats that reside in my home must be spayed/neutured before receiving food. HSHV can assist with low cost or free spay/neuter, if needed.

I understand that I may not acquire new animals, breed my current animals or adopt animals from HSHV while in the program.

I understand that this program is meant as a temporary supplement to pet food and enrollment is for up to 6 months. Eligibility will be reviewed after that time.

By signing, I am declaring that the information above is correct. I agree to return food bucket(s) and withdraw from the program when I am able to afford food for my animal(s). *

Yes, I agree to this statement.

If you are human, leave this field blank.

Bountiful Bowl Community Partner Application

Membership Terms

Bountiful Bowls Community Partner Application

Household Members

Your Companion Animals

Your Veterinarian

Humane Society of Huron Valley

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