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 Name Required
Last Name Required

Address

Address line 1 Required
Address line 2
City Required
Country Required
State / Province Required
Zip / Postal Code Required
Email Address Required

Phone Numbers

Required Please enter at least one phone number

Home Phone
Work Phone
Work Extension
Cell Phone
Phone Preference

Text Messaging

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

Misc Fields

Region

Pet Food Bank

Pet 1: Name/ Nombre del Mascota Required

Species / Especie Required

Weight / Peso Required

Dry Food Needed (Kibble)/ Necesita Comida Seca/ Croqueta? Required

Wet Food Needed / Necesita Comida de Lata? Required

Litter Needed / Necesita arena para gatos? Required

Flea Medication Needed / Necesita tratamiento contra las pulgas? Required

Allergies or Special Requests / Su mascota tiene alguna alergia o usted tiene una petición especial?

Pet 2: Name / Nombre de Mascota

Species / Especie

Weight / Peso

Dry Food Needed (Kibble)/ Necesita Comida Seca/ Croqueta?

Wet Food Needed / Necesita Comida de Lata?

Litter Needed / Necesita arena para gatos?

Flea Medication Needed / Necesita tratamiento contra las pulgas?

Allergies or Special Requests / Su mascota tiene alguna alergia o usted tiene una petición especial?

Pet 3: Name / Nombre del Mascota?

Species / Especie

Weight / Peso

Dry Food Needed (Kibble)/ Necesita Comida Seca/Croqueta?

Wet Food Needed / Necesita Comida de Lata?

Litter Needed / Necesita arena para gatos?

Flea Medication Needed / Necesita tratamiento contra las pulgas?

Allergies or Special Requests / Su mascota tiene alguna alergia o usted tiene una petición especial ?

Pet 4: Name / Nombre del Mascota?

Species / Especie

Weight / Peso

Dry Food Needed (Kibble)/ Necesita Comida Seca/ Croqueta?

Wet Food Needed / Necesita Comida de Lata?

Litter Needed / Necesita arena para gatos?

Flea Medication Needed / Necesita tratamiento contra las pulgas?

Allergies or Special Requests / Su mascota tiene alguna alergia o usted tiene una petición especial?

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