Spay Neuter Assistance Program
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pet Information
*
Animal Name
Dog or Cat?
Breed & Sex
Colour & Weight (specify kg or lbs)
Age
If Male, have both testicles descended?
*
Yes
No
Unsure
For Female dogs, when was your pet's last heat?
*
Does your animal have a hernia?
*
Yes
No
Unsure
Please note any known medical conditions
*
Please note any known behaviour issues
*
Has your pet every required a muzzle for handling before?
*
HouseHold Information
Number of people in household
*
Total annual income from lin 150 of your most recent notice of assessment
*
Name
*
First Name
Last Name
Yes, I would like to receive emails from The Humane Society of Kitchener Waterloo & Stratford Perth, 250 Riverbend Drive, Kitchener, Ontario, Canada N2B 2E9. Website: kwsphumane.ca. Phone: 519-745-5615. I understand that I can unsubscribe at any time using the unsubscribe button found at the bottom of every email.
*
Yes
No
Submit
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