Spay/Neuter Registration

CLINIC POLICY - If you fail to show up to your scheduled clinic date after confirming you will be there - you will lose your deposit and will need to re-register. *To avoid this you must cancel/reschedule at least 48 hour prior. Our clinics are only offered to Athens County residents who qualify as low income. (see info below) To qualify for reduced spay or neuter prices you must: 1. Provide proof of Athens Co. residency with a photo I.D., utility bill, etc. 2. Provide proof of financial assistance from one of the listed qualifications - •Ohio Works First schedule letter •Ohio Direction Card •WIC card •Section 8 housing voucher •Ohio Medicaid Card •Veterans Benefits Administration letter acknowledging service-related disability •Supplemental Security Income benefits letter •Disability benefits letter from the Social Security administration •Current tax return showing that your family income does not exceed 150% of the U.S. Department of Health and Human Services poverty guidelines (Bank statements and pay stubs do not qualify) **

I HAVE READ AND UNDERSTAND THIS POLICY

NON-REFUNDABLE DEPOSIT - This amount will be deducted from your bill on your scheduled clinic date. *However, if you don't show up for your appointment this will not be refunded and you must re-register paying the deposit again. *If you are unable to pay the below deposit with a credit card online and need to register in person - email us at spayneuter@athenshumane.org YOU MUST PAY THE DEPOSIT PER ANIMAL YOU ARE WANTING TO SCHEDULE.*

Non-Refundable Deposit for Pet #1

This amount will be deducted from your bill on your scheduled clinic date. *However, if you don't show up for your appointment this will not be refunded and you must re-register paying the deposit again.

$25.00

Non-Refundable Deposit for Pet #2

This amount will be deducted from your bill on your scheduled clinic date. *However, if you don't show up for your appointment this will not be refunded and you must re-register paying the deposit again.

$25.00

Non-Refundable Deposit for Pet #3

This amount will be deducted from your bill on your scheduled clinic date. *However, if you don't show up for your appointment this will not be refunded and you must re-register paying the deposit again.

$25.00

Non-Refundable Deposit for Pet #4

This amount will be deducted from your bill on your scheduled clinic date. *However, if you don't show up for your appointment this will not be refunded and you must re-register paying the deposit again.

$25.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

YESNO

Email

example@example.com

FOR CATS -List cats name & gender (ex. Chester, Male)

FOR DOGS -List dogs name, gender and approx weight (ex. Spot, Male, 45 lb.)

Please attach a pic of your proof of financial assistance (example - Medicaid Card, Ohio Direction Card etc...) *IF YOU CAN NOT ATTACH HERE - You MUST show proof of financial assistance on the day of your appointment or your pet will not be seen.

Spay/Neuter Registration

Credit Card

REGISTRATION FORM -