Humane Society of Washington County Spay/Neuter Signup Form
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Phone Number (please list a working number with a functioning voicemail box)
*
-
Area Code
Phone Number
Can we text you at this number?
*
Yes
No
E-mail
*
Cat Info
List the amount of cats and their genders you need help with getting fixed. Use your best estimate.
Female cats
Male cats
Unsure of gender
Cat type
Pet cat (indoor only, or goes in and out)
Outdoor but can easily pick up
Outdoor but can lightly touch but not pick up
Completely feral/can't touch (risk of harm to human)
Do you have traps?
Yes
No
If you have traps, how many traps do you have?
Do you physically need help trapping your cats or crating/leash-walking your dog(s)?
Yes, I am physically unable to handle traps
No, I can do it with some guidance
Anything else you want us to know?
Dog Info
List the amount of dogs and their genders you need help with getting fixed. Use your best estimate.
Female dog(s)
Male dog(s)
List each dog's name, gender, age, weight:
Are you on any form of Government assistance/program? (Check all that apply)
*
Energy Assistance Program
Food Stamps (Hoosier Works)
HIP (Healthy Indiana Plan)
Major VA Disability
Medicaid (not Medicare)
Public School Free Lunch Program
Section 8 Housing
Social Security Disability (SSD - Not Social Security Retirement Income)
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Supplemental Security Income (SSI)
Not on any government program
Please verify that you are human
*
Submit
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