CAT SPAY/NEUTER ASSISTANCE APPLICATION
To apply for assistance to spay/neuter your cat, please fill in all sections of this form and mail it to HSWC, P.O. Box 51, Salem, IN 47167 or email it to ddaugh@blueriver.net. If you are found eligible, a voucher will be mailed to you. The amount of the voucher will be $25 for a female cat and $15 for a male cat. Please wait to receive your voucher before scheduling surgery.
Eligibility Requirements:
1. You MUST need financial assistance to help pay for the spay/neuter.
2. You MUST be a resident of Washington County.
Vouchers are issued on a first come, first served basis. Money for the Spay/Neuter Assistance Program comes from donations and/or fund raising projects by the Humane Society of Washington County. Please use this service only if you cannot afford the entire cost of the surgery.
Assistance given for a maximum of 2 cats. You may reapply for additional cats after 12 months.
Name_________________________________________________ Driver’s Lic # ______________
Address ___________________________________________________
City _______________________ State _______ Zip ____________
Home Phone _____________ Day Phone _____________
Email address________________________________________
Are you employed? _______ If yes, where __________________________________________
Do you need this assistance? Yes ____ No ____
Is your cat Male ____ Female ____ Color _______________ Age _____
Have you used this program before? Yes ____ No ____
If yes, when _______ What was the sex and number of animal(s)? Male ____ Female ____
I understand that by signing this form I agree to have my pet spayed/neutered and;
I understand the HSWC does not maintain any responsibility toward my pet and;
I understand that in the event I am found not eligible, I may appeal the decision at a regularly scheduled board meeting.
Veterinarian who will perform the surgery: __________________________________
Signature _______________________________________ Date ______________________