LOW INCOME ASSISTANCE APPLICATION

The reason for Spay/Neuter Assistance (COMPLETE ALL OR MARK N/A if not applicable)

List allHousehold members other than yourself. Indicate Full Time or Part Time forthose employed or state student, unemployed, retired, disabled, etc.

By typing my full name here and dating this application, I affirm that the above information is true and correct

SPAY/NEUTER SURGERY – Must be PREPAID (including vaccinations, other services) prior to scheduling. NO REFUNDS.

The Grant covers the cost of surgery up to 50lbs. All pets must either receive a rabies vaccination at a cost of $10 or show proof of a current vaccination certificate. A cone and pain medication for dog post-surgical care is required at an additional cost (see box). All patients will be given a pre-surgery exam the day of surgery.

Please carefully read the following:

Additional fees/charges may apply at time of pick-up due to higher weight, unexpected pregnancies, cryptorchid surgeries, umbilical hernias, or other services that may be needed for your animal at our veterinarian’s discretion. If any animal has live fleas, a capstar will be given to kill fleas immediately and to keep the surgery site sterile. An additional charge of $5 per capstar will be due at pick-up. You will be notified of any additional costs the day of your appointment. All cats MUST arrive in carriers, and dogs must be leashed. NO CHECKS are accepted in office day of surgery.

After we receive your application and proof of income we will contact you. You will be required to pay what the grant does not cover before an appointment is made. Appointments are not made until all payments are received.

NOTE: If paying with PayPal, please use the "Donate" button at the top of the page.

By signing below I, the owner, acknowledge that I have read and understand this statement, and that I am responsible for all payments due at time of pick-up. I will pay any additional fees/charges that are due in office in addition to what I have sent with this application. Also, I understand there are no refunds for any reason. MTSNC will issue credit, I may pick additional services or I may donate any remainder to our sponsorship fund. MTSNC is a nonprofit 501(c)3 organization with the mission of reducing pet overpopulation and euthanasia in animal shelters.