Section 4: Emergency Contact Contact 1 (Required)
Section 5: Adoption Information
Please provide information on who will adopt your companion animal(s) should the need arise.
Also, please keep all companion health records and registration papers in proper order and
(Required) Section 6: Verification of Eligibility
In order to register as a client of PALS, please attach verification of the following 4 documents:
*Proof of Medical Disability & Diagnosis (physician’s letter confirming debility due to illness)
*Proof of spay/neuter of your companion animal(s) (certificate issued by veterinary )
1. Proof of residency (Required)
This can be a GA Driver's License, utility bill, or rental agreement. Only residents of the following Georgia counties may apply: Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, Rockdale.
2. Proof of Income (Required)
This can be SSI/or SSD award letter or bank statement.
3. Proof of Medical Disability & Diagnosis (Required)
Physician's letter confirming debility due to illness or disability.
Note: If you're an elderly, you don't need to provide proof of Medical Disability & Diagnosis. 4. Proof of spay/neuter of companion animal(s) (Required)
This is a certificate issued by your veterinary doctor.
Drop files here or
Max. file size: 100 MB. Section 7: Consent to Release Information/Statement of Fact Consent (Required) I agree to the statements below.
I hereby authorize PALS and its representatives to share/access information with/from relevant agencies regarding services I have received and/or requested.
- I hereby certify by my signature below that the information I have provided to PALS is true and correct to the best of my knowledge. I also understand that any false information provided to PALS will result in permanent termination of services.
- I hereby authorize PALS and its representatives to perform home visits prior to application approval and routinely throughout my time as a client. Signature - Name (Required)
PALS CLIENT DEMOGRAPHIC INFORMATION
We are often asked by private foundations for demographic information about our clients. The following will be used for grant applications and will not be considered as a part of your application to join our program. We appreciate your assistance in helping us secure funding by providing this information. Only residents of the following Georgia counties may apply: Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, Rockdale.