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We are asking you to donate $1.00 per pet in your household or in memory of a pet that has passed away. Your pet's name will be placed on a Paw Print that will hang in the annex building until the end of the challenge on May 31,2013. PLUS! You can order a custom photo button with a picture of your pet for only $5.00 extra. Buttons will be mailed to you at no extra charge. Together, we WILL make San Antonio a no-kill city!
Name: Address:

Phone #: Email*:



List Pets Names:

Memorial Donation for:

D YES! I would like photo buttons of my pet(s)* *once payment and order for buttons has been received we will request photos of sent via email so please be sure your email address is included on this form.
# ofpets

x $1.00

# of buttons x $5.00 = $ ----------Total Donation Sent: $ _

D Check Included (please include birthdate and driver's license # D Please charge my credit card for the total listed above. A cashier will call you for credit card information upon receipt of this

Mail this form with donation to: Dollar Per Pet Challenge c/o Animal Care Services 4710 Hwy 151 San Antonio, TX 78227