Vet Care/Desexing Application and Consent Form

This application does not guarantee your pet's place in the program.

The Stay Foundation endeavours to assist as many pets and their guardians as possible. Please understand that funding and positions in the program are limited.

We will be in touch within 7 days via email to advise whether or not you have secured a place and advise of the next steps.

Please ensure you check your spam/junk email folders if you have not received a response.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Please provide proof of residence by uploading a copy of your Driver's License or proof of residence such as a copy of a household service bill , phone bill, council rates (in your name at your current address) etc*

Have you been referred to The Stay Foundation by a third party?*

YesNo

If yes please provide the name of the referring organisation, a contact name, email and phone number

Are you a Housing NSW Resident?*

YesNo

Are you currently on a pension or receiving Centrelink benefits?*

YesNo

Please upload a copy of your Pension card or proof of receipt of Centrelink benefits

Please tell us a little about your current situation and why you are seeking assistance with veterinary costs. This helps us better understand your circumstances and how we can best support you and your pet.*

Do you consent to The Stay Foundation taking photos/videos of your pet to be used on our social media or advertising material? Please note names will be changed to protect privacy.*

YesNo

Please note that The Stay Foundation is unable to transport your pet to and from their vet appointments. Are you able to transport your pet to and from the vet appointment?*

YesNo

What kind of Pet do you have?*

DogCatOther

Pet's Name*

Pet's Age*

Breed*

Pet's sex*

Pet's weight if known

Color*

Is your pet desexed?*

YesNo

Do you want your pet desexed?*

YesNo

Is your pet microchipped in your name and registered with Council?*

YesNo

Microchip number if known

If your pet is not microchipped, do you agree to have a microchip implanted, this is required by law and will be provided FREE of charge if your pet is being desexed at the same time.

YesNo

Are your pet's vaccinations up to date? If not, this will be provided FREE of charge if your pet is being desexed at the same time..*

YesNo

What vet services do you require?*

DesexingVaccinationMicrochippingOther

If other, please provide the details of the vet services required

Please note:

If you have selected “Other Veterinary Services,” The Stay Foundation may provide financial assistance for veterinary fees on the condition that your pet is also desexed, microchipped, and vaccinated, where this has not already been done. This is to promote responsible pet ownership.

By accepting assistance, you agree that desexing, microchipping, and vaccination will be carried out at the same time as the other veterinary services, or as soon as reasonably practicable thereafter.

Please also ensure that desexing, microchipping, and vaccination are selected above if your pet has not yet had these procedures and they are required.

If your pet is undergoing desexing surgery, have they been well over the last 14 days?*

YesNo

Is your pet currently taking any medications?*

YesNo

If yes, what type of medication are they taking?

If your pet is female, are they on heat?

YesNo

If your pet is not on heat, when was the last time they were?

If your pet is male, have both testes descended?*

YesNo

The Stay Foundation will coordinate and cover the cost of veterinary procedures on your behalf. However, to secure your pet’s place in the program, a non refundable fee is required. If your application is successful, we will contact you with instructions on how to make the payment and outline the next steps in the process.

By signing this application, I acknowledge and agree to the following:

I confirm that I am over 18 years of age, the legal owner of the pet listed above, and that all information provided is true and accurate to the best of my knowledge.
I understand that The Stay Foundation reserves the right to cancel or postpone any procedure at its discretion and without prior notice.
I acknowledge the risks associated with anaesthesia and surgical procedures. I understand that only a basic pre-anaesthetic evaluation (excluding blood tests) will be performed and accept the risks associated with any undetected underlying conditions.
I accept that The Stay Foundation covers only the procedure listed in this application and is not liable for any complications (including death or permanent injury) or associated costs that may arise during or after surgery.
I understand that any medical conditions identified during examination or surgery will be communicated upon discharge, and that no additional treatments will be provided under this program. Any further treatment required is my sole responsibility.
I agree to cover any costs not explicitly approved in writing by The Stay Foundation.
I accept full responsibility for providing appropriate post-operative care, including adequate food, water, shelter, and monitoring of my pet during recovery.
I understand that failure to follow the post-operative care instructions may result in complications for which The Stay Foundation is not responsible, financially or otherwise.
I agree to release, indemnify, and hold harmless The Stay Foundation, its staff, veterinarians, and volunteers from any and all claims, damages, injuries (including death), or losses arising from or connected to the services provided.
I hereby authorise the veterinarian engaged by The Stay Foundation to perform the procedure listed and consent to treatment as described under the terms of this waiver.

I have read, understood, and agree to the terms outlined above.
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Did you require assistance with completing this form?*

YesNo

If yes, please provide the name of person who assisted you in completing this form and their relationship to you

Signature

Date

We will be in touch as soon as possible via email to advise of next steps. Please ensure you check your spam/junk email folders if you have not received a response.

Community Vet Care Program