We have funding to assist families with the cost of this very important procedure. Here are the guidlines for those we can assist. Please contact us if you meet these guidelines about us helping you spay or neuter your pet. When submitting your application, please include a copy of any income. Be part of the solution, not the problem!
Persons in Family or Household Income
1 10,210
2 13,690
3 17,170
4 20,650
5 24,130
6 27,610
7 31,090
8 34,570
For each additional person , add 3,480
APPLICATION FOR SPAY / NEUTER SERVICES Below is our application for spay/neuter services through the Animal Rescue of Stokes County.If you wish to be considered for spay/neuter through this program, this application must be completed entirely (incomplete applications will not be considered).In order to qualify for this program, you must be a resident of Stokes County, you must have a completed application, and you must have demonstrated need of why you are unable to pay for the spay/neuter procedure yourself.Additional information may be required.
If you application is approved, you will be contacted by phone to get further information on how to proceed.Each animal that is approved has to have a rabies vaccine.If you have already had the animal vaccinated, proof must be shown.If you have not yet had the animal vaccinated, the vaccine can be given at the time that the procedure is done AT THE OWNERS EXPENSE!State law requires a current rabies vaccination for any dog or cat four months or older.You will be responsible for transporting the animal to and from the facility providing the spay or neuter.
Please Print Name ______________________________________ Age _____________________ Address ______________________________________________________________ City ______________________________ State __________ Zip ________________ Telephone (Home) _____________________ Cell Phone ______________________ What is the best time to reach you?__________________________________ Marital Status ______ Single _______ Married _______ Separated ______Divorced Number in Your Household (You count as one) _______________ Total Family Income Per Year $ _________ (Please include income from all sources) Do you have ______ Medicaid card ________ WIC _____ AFDC _____ Food Stamp Welfare Case Number ______ Other (please list) ______________________________ Place of Employment _____________________________________________________ Address: ________________________________________ City ___________________ Telephone Number _______________________________________________________ How long have you been employed by this company? __________________________ How many animals do you currently own? _____________________________ Please fill in the information on ALL the animals that you own below.
Dog or Cat
Name
Age
Sex
Breed
Last Distemper Shot
Last Rabies Shot
Feline Leukemia Tested
Spayed Or Neutered
Which animals are you requested assisted spay/neuters?(List animals needing spay/neuter) _______________________________________________________ Any additional information that you would like for us to consider: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
I understand the above requirements and certify that the information on this application is correct to the best of my knowledge.I understand that failure to disclose information will be seen as a violation of policies and will result in the termination of this application.
Signature _________________________________ Date ______________________