*Only 1 reference can be a relative & that relative must not live with you. All references must be 18 years of age or older.*
I certify that the information given on this form is true and correct and I recognize that any misrepresentation of facts will
result in my being unable to adopt a pet from PVHS. I understand that submission of this application does not guarantee
adoption and that approval or denial of this application is at the sole discretion of PVHS.