Cat Spay/Neuter Assistance Application 23

Cat Spay/Neuter Assistance Application

This program is for Saginaw County residents that are unable to afford spay or neuter surgery only please.
Name*

First NameLast Name
Email
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
How did you find out about the program?
To Qualify:

We may request proof of income be provided at time of surgery scheduling. We need a recent copy of pay stubs, unemployment, disability, or veteran benefits of ALL adult household members to determine eligibility. This program is designed for those that sincerely cannot afford to fix their pets on their own. Thank you.
Total number and ages of people living in the household?*
Total annual household income (include all sources of income-ssi, unemployment)?*

$0-$10,000$10,001-$30,000$30,001-$50,000$50,001-$75,000
Are you:*

UnemployedPart-time employedFull time employedOn disabilityReceive government assistance
How many cats and kittens are there inside your home?
How many cats and kittens are there that you care for outside your home?
CAT 1 NEEDING SPAY/NEUTER
Name of the Pet:*
Gender?*

MaleFemale
Age?*

Under 3 months3-6 months6-12 months1-5 years5+ years5-8 yearsSenior (8+)
Weight?*

less than 2 pounds2-3 pounds4-7 pounds8-12 pounds12+ pounds
How long have you owned the pet ?*
Is this cat currently pregnant?*

YesNo
Is this cat currently, or has recently finished nursing kittens?*

YesNo
If this is a momma cat, how many kittens are there and how old are they?
Are you or an adult you trust able to transport your pet to Flint, Michigan where the surgery will be performed?*

YesNo
How much money are you able to contribute towards the spay or neuter of your cat?*

$10$20$30$40None
Has this cat ever been seen by a vet?*

yesno
Has this cat ever received vaccines*
Are there any known medical conditions that we need to know about?*
Where did you get this pet from?*
CAT 2 NEEDING SPAY/NEUTER
Name of cat:*
Gender?*

MaleFemale
Age?*

Under 3 months3-6 months6-12 months1-5 years5+ years5-8 yearsSenior (8+)
Weight?*

less than 2 pounds2-3 pounds4-7 pounds8-12 pounds12+ pounds
Is this cat currently pregnant?*

YesNo
Is this cat currently, or has recently finished nursing kittens?*

YesNo
If this is a momma cat, how many kittens are there and how old are they?
Has this cat ever been seen by a vet?*

yesno
Has this cat ever been seen by a vet?*

yesno
Has this cat ever received vaccines?*

yesno
Are there any known medical conditions that we need to know about?*
Are you or an adult you trust able to transport your pet to Flint, Michigan where the surgery will be performed?*

YesNo
Are you or an adult you trust able to transport your pet to Flint, Michigan where the surgery will be performed?*

YesNo
How much money are you able to contribute towards the spay or neuter of your cat?*

$10$20$30$40None
How long have you owned the pet?*
Where did you get the pet from?*
Are you or an adult you trust able to transport your pet to Flint, Michigan where the surgery will be performed?*

YesNo
Additional comments:
CAT 3 NEEDING SPAY/NEUTER
Name of cat:*
Gender?*

MaleFemale
Age?*

Under 3 months3-6 months6-12 months1-5 years5+ years5-8 yearsSenior (8+)
Weight?*

less than 2 pounds2-3 pounds4-7 pounds8-12 pounds12+ pounds
Is this cat currently pregnant?*

YesNo
Is this cat currently, or has recently finished nursing kittens?*

YesNo
If this is a momma cat, how many kittens are there and how old are they?
How much money are you able to contribute towards the spay or neuter of your cat?*

$10$20$30$40None
Where did you get the pet from?*
How long have you owned the pet?*
Additional comments:
If you have more than 3 cats or kittens requiring spay or neuter please fill out an additional application.
Should be Empty: