I hereby request permission to keep the following described pet in my dwelling unit:

Type of Pet:  __________      Age:  __________

Size: __________       Color: __________

I have read and agree to abide by all  Pet Ownership Policies established by the Provincetown Housing Authority (PHA).  I further agree that it is my sole  responsibility  to responsibly care for and clean-up after my pet, and understand that  this  Agreement shall permit the PHA, in its sole discretion, to  take  action to  remove the pet from my  unit if the PHA believes that the animal is not properly cared for or shows signs of abuse.

I hereby release the Provincetown Housing Authority of any and all liability caused by, relating to or associated with my pet.

Signature of PHA Resident Signature of PHA Representative

Date Date

{Paste Color Photograph of Pet here}


I _________________________, do hereby agree to act as temporary/permanent Caretaker, if necessary, for the care and responsibility of the companion animal that belongs to:

Name of Resident: _____________________

Apartment No.: ________________________ _

Description of Pet: ______________________ _

I represent to PHA that it will be my responsibility to remove the animal from the premises if the aforementioned owner of the pet dies, is incapacitated or is other wise unable to care for the pet, whether it be for a short duration or on a permanent basis.

I further understand that this Agreement shall permit the PHA, in its sole discretion, to take action to remove the pet from the unit if the PHA believes the animal is  not properly cared for or shows signs of abuse.

___________________________                            ___________________________

Signature Date


City & State ____________________________________________________

Telephone Number _______________________________________________

Email __________________________________________________________


Name of PHA Resident Unit Address

Pet: ________________________   _______________    ____________________

Type  & Breed (Dog/Cat) Weight (Approx.) Name Age

Type of Animal:    Service _____   Comfort _____    Pet _____

Copy of Pet Ownership Policy Provided Certification of City License (if required) Veterinarian’s Certification of Inoculations Veterinarian’s Certification of Spaying or Neutering Pet Caretaker Agreement

Pet Ownership Agreement Color Photograph

Exclusion for Animals that Assist Persons with Disabilities.

3rd Party verification that the tenant, or a member of his/her family is a person with a disability;

3rd Party verification that the animal has been trained to assist persons with a certain disability, and that the animal will actually assist an PHA resident having such a disability.

Name of PHA Representative

Date: ___________