ANIMEALS PET FOOD PANTRY CLIENT REGISTRATION
Please complete the following information to the best of your ability. If you have four or more
pets, complete a second registration form.
• Mail the completed form to The Reverend John Heschle, Rector (AniMeals), St. Paul’s
Church by-the-Lake, 7100 N. Ashland Blvd, Chicago, IL 60626 OR
• Give the completed form to a volunteer when you attend your first distribution day.
Emergency Contact Name*
Emergency Contact Phone Number*
Veterinarian's Phone Number
Social Security Income
Medicare or Medicaid
SNAP (Food Stamps)
Other Public Assistance
Preferred Distribution Site*
You may pick up food from either location, but please check the location you prefer.
St. Paul's Church by-the-Lake
Chicago Uptown Ministry
Your Last Name __________________________________________
First Pet’s Name __________________________________________
First Pet's Information*
Please check all that apply to this pet only.
Other small animal
Less than 1 year old
1 through 8 years old
Older than 8 years
Vaccinated within the last 6 months
Vaccinated within the last year
Vaccinated within the last 2 to 3 years
I have had this pet less than 1 year.
I have had this pet 1 through 3 years.
I have had this pet more than 3 years.
Your Last Name ____________________________________________
Second Pet's Name __________________________________________
Second Pet's Information
Please check all that apply to this pet on