MyImpactPage - Peninsula Humane Society & SPCA

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Account

Username

Required

	Username must not start with space
	Username must not end with space
	Username must not have two or more spaces in a row

Password

Required

	Password needs to have at least 8 characters.
	Password needs to have at least one upper case character.
	Password needs to have at least one lower case character.
	Password needs to have at least one number.

Confirm Password

Required

	Password needs to have at least 8 characters.
	Password needs to have at least one upper case character.
	Password needs to have at least one lower case character.
	Password needs to have at least one number.

Name Fields

First NameRequired
Last NameRequired

Address

Address line 1Required
Address line 2
CityRequired
CountryRequired
State / ProvinceRequired
Zip / Postal CodeRequired
Email Address Required

Phone Numbers

Required Please enter at least one phone number

Home Phone
Work Phone

Cell Phone
Phone Preference

Text Messaging

I want to receive text messages on my cell phone.
Cell Phone Number

Misc Fields

Region
reCAPTCHA

Pet Food Bank

Pet 1: Name Required

Species Required

Weight Required

Dry Food Needed (Kibble) Required

Wet Food Needed Required

Litter Needed Required

Flea Medication Needed Required

Allergies or Special Requests

Pet 2: Name

Species

Weight

Dry Food Needed (Kibble)

Wet Food Needed

Litter Needed

Flea Medication Needed

Allergies or Special Requests

Pet 3: Name

Species

Weight

Dry Food Needed (Kibble)

Wet Food Needed

Litter Needed

Flea Medication Needed

Allergies or Special Requests

Pet 4: Name

Species

Weight

Dry Food Needed (Kibble)

Wet Food Needed

Litter Needed

Flea Medication Needed

Allergies or Special Requests

PHS/SPCA Pet Food Bank Agreement

To receive pet food assistance from PHS/SPCA, I understand and agree to the following:

• I am a resident of San Mateo County and experiencing financial hardship.
• I understand that I can receive food for up to 4 pets per household each month
• I understand that food is donated to PHS/SPCA, and the same brand or type of pet food cannot be guaranteed each month.
• I understand that PHS/SPCA is not liable for any stomach upset from food or treats given out at its pet food bank.
• I agree not to add any new pets to my family while receiving pet food assistance from PHS/SPCA.

I agree with the Pet Food Bank Policies Required