WAG Sign Up Form

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WAG Sign Up Form

WAG stands for Wellness at Gateway and is an exclusive pet perks program for residents of the East Side Pet District (zip codes 62201, 62203, 62204, 62205, 62206, and 62207) who have spayed/neutered all of their pets and who can provide proof of need. The perks include ongoing access to free and/or discounted pet food, discounts at our retail store and vet clinic and more.

Applicants will need to provide verification of residency, proof of need and proof of spay/neuter to qualify for the WAG program.

Make sure names are spelled correctly (ask client to spell if you are unsure) and address and phone numbers are accurate (repeat back to client).

Note: A receipt from this form is not sent to the client after completion.

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Type of request

Welcome center/retail store walk-in

Public clinic client

Client initiated call

Outreach visit

其他：

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Owner's last name *

Owner's first name *

Owner's street address *

Owner's zip code *

62201

62202

62203

62204

62205

62206

62207

Other (Note: This form should only be submitted if clients live in the zip codes above)

Owner's phone number (include area code) *

Owner's email address

PET #1: Include pet's size. *

Small Dog (0-25 pounds) | 10 pounds of food

Medium Dog (25-50 pounds) | 20 pounds of food

Large Dog (50-75 pounds) | 30 pounds of food

Extra Large Dog (75+ pounds) | 40 pounds of food

Cat | 6 pounds of food

PET #1: Include pet's name, species, breed, color, age. *

Is this pet spayed or neutered?

Yes- surgery was done through GPG

Yes- surgery was done elsewhere

Pending- currently on GPG wait list to have pet spayed/neutered

No (please note all pets must be spayed/neutered to be eligible for food pantry services)

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PET #2: Include pet's size.

Small Dog (0-25 pounds) | 10 pounds of food

Medium Dog (25-50 pounds) | 20 pounds of food

Large Dog (50-75 pounds) | 30 pounds of food

Extra Large Dog (75+ pounds) | 40 pounds of food

Cat | 6 pounds of food

清除選取的項目

PET #2: Include pet's name, species, breed, color, age.

Is this pet spayed or neutered?

Yes- surgery was done through GPG

Yes- surgery was done elsewhere

Pending- currently on GPG wait list to have pet spayed/neutered

No (please note all pets must be spayed/neutered to be eligible for pantry services)

清除選取的項目

PET #3: Include pet's size.

Small Dog (0-25 pounds) | 10 pounds of food

Medium Dog (25-50 pounds) | 20 pounds of food

Large Dog (50-75 pounds) | 30 pounds of food

Extra Large Dog (75+ pounds) | 40 pounds of food

Cat | 6 pounds of food

清除選取的項目

PET #3: Include pet's name, species, breed, color, age.

Is your pet spayed/neutered?

Yes- surgery was done through GPG

Yes- surgery was done elsewhere

Pending- currently on GPG wait list to have pet spayed/neutered

No (please note all pets must be spayed/neutered to be eligible for food pantry services)

清除選取的項目

PET #4: Include pet's size.

Small Dog (0-25 pounds) | 10 pounds of food

Medium Dog (25-50 pounds) | 20 pounds of food

Large Dog (50-75 pounds) | 30 pounds of food

Extra Large Dog (75+ pounds) | 40 pounds of food

Cat | 6 pounds of food

清除選取的項目

PET #4: Include pet's name, species, breed, color, age.

Is your pet spay/neutered?

Yes- surgery was done through GPG

Yes- surgery was one elsewhere

Pending- currently on wait list at GPG to have pet spayed/neutered

No (please note all pets must be spayed/neutered to be eligible for food pantry assistance)

清除選取的項目

PET #5: Include pet's size.

Small Dog (0-25 pounds) | 10 pounds of food

Medium Dog (25-50 pounds) | 20 pounds of food

Large Dog (50-75 pounds) | 30 pounds of food

Extra Large Dog (75+ pounds) | 40 pounds of food

Cat | 6 pounds of food

清除選取的項目

PET #5: Include pet's name, species, breed, color, age.

Is your pet spayed/neutered?

Yes- surgery was done through GPG

Yes- surgery was done elsewhere

Pending- currently on wait list at GPG to have pet spayed/neutered

No (please note that all pets must be spayed/neutered to be eligible for pantry services)

清除選取的項目

ALL ADDITIONAL PETS: Include pet's name, species, breed, color, age. Note any medical issues.

Name of the person submitting this form *

What happens next? (Script to read clients)

A GPG staff member will contact you within 7 days. You will then receive a WAG (Wellness at Gateway) card and a welcome packet with information about the perks of the program and information about free or discounted food distribution.

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