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Animal Services
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» Fencing Assistance Application
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Fencing Assistance Application
The Animal Center accepts
fencing donations
from the public and gives them to citizens in need.
Name and Contact Information
Name:
*
Enter first and last name.
Date of Birth:
*
Date must be in format mm-dd-yyyy. (Example: 01-31-1980)
Address (Line 1):
*
Address (Line 2):
City:
*
State:
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code:
*
Enter the five-digit ZIP code. (Example: 78701)
Phone Number:
*
Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)
Alternate Phone Number:
Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)
E-mail:
Household Information
Number of Dependents in Home:
Dependent's Name and Age:
Dependent's Name and Age:
Dependent's Name and Age:
Dependent's Name and Age:
Dependent's Name and Age:
Legal Name of Spouse/Partner:
Income and Employment Information
Total Annual Household Income:
$
Supplemental Income:
$
Supplemental income may include food stamps, Medicaid, etc.
Are you currently employed?
Yes
No
If employed, enter the name of your employer:
Is your spouse/partner employed?
Yes
No
If employed, enter the name of his/her employer:
Property Information
Do you own your home?
*
Yes
No
If you do not own it, do you have permission by the homeowner to build on the property?
Yes
No
NOTE: Written consent from the owner must be submitted.
Is the yard big enough to hold a 150 square foot pen?
*
Yes
No
I am applying for materials to reinforce an existing fence.
Yes
No
I am applying for materials to build a new fence.
Yes
No
Pet Information
Dog #1
Dog's Name:
Dog's Age, Sex and Breed:
Example: 4 years, Female, Yorkie
Describe the dog's weight, color and markings:
Rabies Tag Number:
*
Date the Rabies shot was given:
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
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19
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23
24
25
26
27
28
29
30
31
Year
Year
2010
2011
2012
2013
2014
I can provide a copy of the dog's Rabies certificate.
*
Yes
No
The dog is spayed or neutured.
*
Yes
No
The dog is/has:
Heartworm-positive and being treated
Heartworm-negative
Not been tested for Heartworm.
Veterinary Clinic Name and Address:
Dog #2
Dog's Name:
Dog's Age, Sex and Breed:
Example: 4 years, Female, Yorkie
Describe the dog's weight, color and markings:
Rabies Tag Number:
Date the Rabies shot was given:
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
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11
12
13
14
15
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18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2010
2011
2012
2013
2014
I can provide a copy of the dog's Rabies certificate.
Yes
No
The dog is spayed or neutured.
Yes
No
The dog is/has:
Heartworm-positive and being treated
Heartworm-negative
Not been tested for Heartworm.
Veterinary Clinic Name and 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.
*
Yes
No
I can provide vet records, proof of income and a letter from the owner of the property (if appropriate).
*
True
False
Please give any information that did not fit into the form that you would like to add.
Leave this field blank
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