Spay/Neuter Assistance Application

Comanche County Pet Resource Foundation

PO Box 6911

Lawton, Oklahoma, 73505

580-736-5499

Email: petresourcefoundation@comanchecountypetresourcefoundation.org

Website: www.comanchcountypetresourcefoundation.org

Your Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail

example@example.com

Phone Number*

What Kind of Pets Do You Have?

	Pet Name	Species	Gender	Spay/Neutered?	Current on Vaccinations?	Pet's Age	Breed
Pet 1
Pet 2
Pet 3
Pet 4

Please Provide Two Photos of the Pet Requiring Assistance. Photos may be used on social media platforms for fundraising purposes.*

Please Provide Proof of Residency in Comanche County*

All Comanche County Pet Resource Foundation clients must adhere to the following requirements to remain active in the programs offered.

I understand that the Comanche County Pet Resource Foundation will assist with the spay/neuter of your pet to help aid in the pet over population crisis in our community*

I understand

I understand that CCPRF uses the Animal Birth Control Clinic in Lawton Oklahoma for spay/neuter procedures. The use of any other veterinary facility must be approved by CCPRF to receive financial assistance from CCPRF.*

I understand

I understand that I must provide proof of current vaccinations at the time of receiving the procedure from the Animal Birth Control Clinic*

I understand

I understand that I must adhere to all requirements from the Animal Birth Control Clinic to receive financial assistance from CCPRF.*

I understand

I understand that I must provide proof of my Comanche County residence at time of enrollment*

I understand

I understand that I will be required to pay 20% of the spay/neuter procedure fee*

I understand

I understand that the Comanche County Pet Resource Foundation has a $200 cap on all spay/neuter assistance per pet*

I understand

I understand that the Comanche County Pet Resource Foundation may use pet photos and veterinary estimates provided by the pet parent for fundraising purposes. This information may be listed on Facebook and other social media platforms.*

I understand

I Understand that the Comanche County Pet Resource Foundation will not assist with routine medical expenses which includes flea and tick medication, yearly exams, fines placed by the city or county, shelter fees, grooming, etc.*

I understand

I Understand that the Comanche County Pet Resource Foundation will assist with pet vaccinations by offering regular free community pet vaccination clinics. CCPRF will not help pay for vaccinations through a veterinarian unless approved by CCPRF. CCPRF does not offer assistance with paying for Rabies vaccinations*

I understand

I Understand that the Comanche County Pet Resource Foundation reserves the right to refuse services to me*

I understand

I understand that the Comanche County Pet Resource Foundation reserves the right to revise, change, and/or assign additional conditions to enrollment to the CCPRF Pet Assistance Program without notice*

I Understand

I,name, acknowledge and understand that any assistance I receive from the Comanche County Pet Resource Foundation is at my own discretion. I understand that Comanche County Pet Resource Foundation programs are supported by private contributions, and thus, CCPRF cannot guarantee services will be available for all programs. I release CCPRF, this program, and it's affiliates from all liability that may arise due to the services and products received through the Comanche County Pet Resource Foundation programs.

Signature

Date

For Official Use

	Information	Comments
Client ID #
Veterinarian Used for Pet Care
Date of verification of spay/neuter
Microchip number
Date of first distribution of food/supplpies/care