PROVINCETOWN HOUSING AUTHORITY PET OWNERSHIP AGREEMENT
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}
PET CARETAKER AGREEMENT
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
Address_______________________________________________________
City & State ____________________________________________________
Telephone Number _______________________________________________
Email __________________________________________________________
PET REGISTRATION CHECKLIST
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: ___________