Annual Registration Update Form
(Required annually on original registration month)
Name
*
First Name
Last Name
Other Adult Household Members
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
None if no email
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Number of Dogs (Max. 3)
*
0 if no dogs
Dogs Name
Weight
Age
How long have you owned?
Breed
Dogs Name
Weight
Age
How long have you owned?
Breed
Dogs Name
Weight
Age
How long have you owned?
Breed
Number of Cats (Max. 3)
*
0 if no cats
Cats Name
Weight
Age
How long have you owned?
Cats Name
Weight
Age
How long have you owned?
Cats Name
Weight
Age
How long have you owned?
Other Pets
Are all of your pets spayed/neutered? (fixed)
*
Yes, all of my pets
No, none of my pets
Some of my pets
Please list all pets that are not fixed
*
N/A if all are fixed
If you have pets that are not yet fixed, how much can you afford to put toward their surgery(s)? (N/A if all are fixed)
*
We work with C-Snip and Fur Wellness. Dog spay/neuter is $155 (C-Snip), cat spay/neuter is $75 (C-Snip). How much of that, if any, can you afford per pet?
What type of food do your pets prefer?
*
Dry Dog
Canned Dog
Dry Cat
Canned Cat
Cat - COMBO (see below)
Dog - COMBO (see below)
Other
If you checked COMBO, please indicate if they like more wet, more dry, etc?
If so, please list. (We are completely donation based so we cannot promise anything specific but we can always look)
Do any of your pets have special dietary needs?
If so, please list. (We are completely donation based so we cannot promise anything specific but we can always look)
Waiver & release of liability
*
I give electronic consent that I've read the form and agree.
Pantry Guidelines/Rules
*
I give electronic consent that I've read the form and agree.
Spay/Neuter
*
I understand that PHPFP requires all pets to be spayed/neutered unless medically unsafe. (If you need financial assistance please let us know!)
I understand & agree to provide proof of spay/neuter OR get a spay/neuter appointment within 30 days of signing up.
New Pets
*
I understand that I will no longer be eligible for assistance if I add any new pets to my household.
I understand that i am also obliged to notify PHPFP if a pet passses.
Donation/Volunteer Based
*
I understand that PHPFP is completely volunteer run & donation based. They cannot guarantee any specific type or amount of food/supplies.
Need Based
*
I agree to only come as needed & take only what I need.
Annual Registration
*
I agree to complete a new registration annually.
Do you authorize anyone else to pick up for you
*
No
Yes, list name
Questions/Comments
Date
/
Month
/
Day
Year
Date
I have read & agree to the above policies
First Name
Last Name
Submit
Should be Empty: