Pet Desexing Subsidisation Program Application

Pet Desexing Subsidisation Program

Application Form
Use this form to apply for a voucher through Hindmarsh Shire Council's Pet Desexing Subsidization Program. You will need to provide proof of a valid concession card and live within Hindmarsh Shire to be eligible. You can apply for a maximum of one animal per household. Pending appointment availability, the following local clinics are supporting this service:
- Your Family Vet
- Fur Life Vet Horsham
- Wimmera Mallee Veterinary Services
If you are successful, Council will contact you to arrange delivery of your voucher and to provide further information.

PRIVACY STATEMENT

We will handle any personal information you have provided in this form in accordance with the Privacy and Data Protection Act 2014. Our privacy policy contains information about how you may access your personal information and seek correction of such information; as well as how to complain about a breach of the Australian Privacy Principles and how we will deal with such a complaint. For more information, please see our Privacy Policy or contact our team on (03) 5391 4444. Your personal information will not be disclosed to any other party unless Council is required to do so by law, has gained your consent to do so or an information privacy principle exemption applies.

Your Details
Upload Copy of Concession Card

If you are unable to do this, you can provide a copy of your concession card in person at one of our Customer Service Centres
Cancelof
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Animal Details
Animal Name
Animal Age
Breed
Sex

MaleFemale

Which is your preferred clinic?

Your Family VetFur Life Vet HorshamWimmera Mallee Veterinary Services

Source Numbers
All cats that are kept as pets within Hindmarsh Shire are required to be registered with Council. In order to be registered they must be microchipped, and in order to be microchipped, you must be able to provide the authorised implanter with a source number.

A source number
- Identifies an individual, breeder, business or organisation.
- Is generated once an individual enrols on the Pet Exchange Register.
- Is automatically allocated to domestic animal businesses (DAB) and foster carers following registration with Council.
In order to participate in this program, you must be able to provide a source number to the participating clinic.

If your cat is not desexed, it is unlikely that you will have a source number. This means that you will be required to register for a source number prior to the appointment.

You can register for a source number ($22.90 application fee as of November 2022) here.

If you require assistance registering for a source number, you can visit any of Council's customer service offices, or call (03) 5391 4444.
*

I understand that I will be required to provide the Clinic with a source number upon booking

By signing below, the Applicant acknowledges that
- The voucher entitles the named recipient to access one of the below standard services at a reduced fee of $50.00 per animal (maximum 1 per household)
- Any additional services, including if any additional medications or processes are required due to the specific needs of their cat, must be paid for privately.
- The recipient acknowledges that Council is not responsible or liable for any complications, unexpected or adverse outcomes of the procedure at the participating clinic.
- The recipient acknowledges that they must have booked the appointment within 30 days of the issue date on the voucher, or contact Council requesting an extension, otherwise the voucher will be deemed invalid. The appointment may be scheduled outside of the 30 day period, but no longer than 90 days from date of issue.
- Their name and phone number will be provided to the participating clinics in order to confirm eligibility upon booking.
- They must register their cat/s with Council within 14 days of the procedure being undertaken. Should they not register their cat/s, Council may issue an infringement for the keeping of an unregistered animal.
Signature*

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