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HPR Supply Donation Form

We Are Paw Obligated To Ask For Donations!

Today's Date *

Donor Name *

First

Last

Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone

Alternate Phone

Email *

Drop off Date & Time

Date

Time

Pick Up Date & Time

Date

Time

Vehicle Type

• SUV
• RV
• Pick up truck.
• Flat Bed Truck
• Van
• Truck + trailor
• Other

Are the supplies on a pallet?

• Yes
• NO

Are these supplies animal medical supplies?

• Yes
• No

Do these supplies require refrigeration?

• Yes
• No

List - Supply inventory.

Can you volunteer your time to distribute supplies in the disaster areas?

• Yes
• No

Paw it Forward (Next)

Have you been exposed to COVID in the last week or so?

• Yes
• No

Have you been vaccinated for COVID 19?

• Yes
• No

Would you commit to wear a mask as a courtesy to others that may be at risk, when dropping off your donated supplies?

By singing this form i agree and understand that the supplies donated by me are donated to Hurricane Pets Rescue Inc. (HPR) for distributions to hurricane affected victims as they see it fit and where the need arises at their discretion. Once my supplies are donated at HPR's staging areas or where intructed by HPR, its affiliates or volunteers to do so, i will have no claim over the donated supplies and i waive all rights to them. My digital signature will serve on this form to confirm the statment above. *

Initial Here,

Applicant Signature: *

Sign electronically above.

Upload a picture of your donated supplies.

Click or drag a file to this area to upload.

Give yourself a treat (Submit)

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