Click on application for PDF file. If you would rather fill out a hard copy form, those are available at:
Grace Lutheran Church
202 2nd St SE
Watertown, SD
Monday-Thursday 8am-5pm

For a paper form, click here.

If you would rather download and print the application, you can find it here:
DOWNLOAD PDF APPLICATION

PET OWNER PERSONAL INFORMATION



List ALL household members

  Household Member 1  


  Household Member 2  


  Household Member 3  


  Household Member 4  


  Household Member 5  


  Household Member 6  


Do you have any of the following (check all that apply):

Pet owners must be receiving on of the following forms of assistance. (If owner is not, there is a section farther on for owner to explain financial hardship.)

Please check the box for each form of assistance received and provide noted documentation.
Unemployment
$ must submit current notification letter


Social Security
$ must submit current notification letter


Disability
$ must submit current notification letter


Medicaid
$ must submit current notification letter


SNAP
$ must submit current notification letter


Military Retirement
$ must submit current notification letter



Or - experiencing financial hardship such as:

Foreclosure (must submit foreclosure statement)

Low Income Status (approval will be on a case by case basis) must submit explanation of current income and most recent tax return

Sudden Medical Expenses (approval will be on a case by case basis) must submit medical bills

PET INFORMATION

Total number of pets in household:



  Pet 1 Information  

Pet name:

Select One: DogCat
Select One: MaleFemale
Age:
Weight:

Current on shots? YesNo
Are they? SpayedCastrated
Are you willing to neuter? YesNo

Food: (please list 3 or more acceptable brands)

1.
2.

3.
4.

Dry food amount per day
Canned food amount per day

Special food needs/allergies

  Pet 2 Information  

Pet name:

Select One: DogCat
Select One: MaleFemale
Age:
Weight:

Current on shots? YesNo
Are they? SpayedCastrated
Are you willing to neuter? YesNo

Food: (please list 3 or more acceptable brands)

1.
2.

3.
4.

Dry food amount per day
Canned food amount per day

Special food needs/allergies

  Pet 3 Information  

Pet name:

Select One: DogCat
Select One: MaleFemale
Age:
Weight:

Current on shots? YesNo
Are they? SpayedCastrated
Are you willing to neuter? YesNo

Food: (please list 3 or more acceptable brands)

1.
2.

3.
4.

Dry food amount per day
Canned food amount per day

Special food needs/allergies

  Pet 4 Information  

Pet name:

Select One: DogCat
Select One: MaleFemale
Age:
Weight:

Current on shots? YesNo
Are they? SpayedCastrated
Are you willing to neuter? YesNo

Food: (please list 3 or more acceptable brands)

1.
2.

3.
4.

Dry food amount per day
Canned food amount per day

Special food needs/allergies


  • I understand this program is for companion animals only.
  • I understand that LAPP is a nonprofit group run by volunteers and relies upon donations.
  • I understand supplies will be provided for 3 pets & this program is meant to supplement my food supply. Please note: If LAPP has extra, we will always try to provide for additional pets in the household.
  • I understand supplies for this program are donated from various sources, therefore the LAPP cannot guarantee the quality or quantity.
  • I understand supplies are limited and the LAPP’s goal is to keep companion pets with their families and out of shelters, therefore, this program is NOT for individual rescuers or group rescuers.
  • I agree to NOT add any new pets to my household. This means if a current pet is no longer with you … you may NOT replace it with a new pet. Our view is if you take on a new pet, you feel you can afford to feed it and you will be removed from the program. I understand that my financial qualifications will be reassessed every 3 months or as the LAPP deems necessary.
  • I agree that if my pets are not neutered, I will have them neutered. LAPP will have vouchers for neutering and rabies vaccinations as funds become available.
  • I agree that my pets are not used for breeding, gambling or fighting.

By electronically submitting this application you agree to the above items and that all
information listed is true to the best of your knowledge.