PPOM Community Partner Agreement Form

1. Type of pet services offered: *

If you selected other, please describe your service:

2. As a community partner for the PPOM program at SDHIPM, I agree to provide my professional pet services for the pets of patients associated with the PPOM program at SDHIPM as follows:

Cost of Services: *

No charge/by donation

Discount: _______%

If your services are being provided at a discount, please enter the amount of the discount here:

3. In return for your generous support, we will promote your pet business through our social media initiatives such as Facebook, Twitter, and "The Caregiver's Corner" blog;, mentions in our newsletters; and inclusion on our PPOM webpage. Please provide the following information exactly as you would like it to appear:

Business name: *

Website address: *

Phone number: *

Submit logo: *

I have agreed to participate as a Community Partner with the PPOM program at SDHIPM by donating or discounting my professional pet services, as specified in question 3 above. I understand that SDHIPM may include my business name, contact information, and/or logo in its social media, newsletter, and website initiatives. I understand that if I would like to terminate my involvement with the PPOM program at SDHIPM, I must notify PPOM by calling 619-278-6451 or by emailing volunteer@sdhospice.org. I also understand that my business information and/or logo may be removed from the PPOM website and /or other publications if the above services are not utilized for 6 consecutive months.

Please read and indicate your agreement to the statement above: *

I agree

I disagree

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