Community Outreach Desexing Program

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.

Please note that should you be successful, you will be required to pay a non refundable deposit to secure your place in the program.

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 identification by uploading a copy of your Driver's License or other form of photographic identification*

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 currently on a pension and receiving Centrelink benefits?*

YesNo

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

Are you a Housing NSW resident?*

YesNo

Please tell us a little about your situation and why you’re requesting assistance with desexing your pet. This helps us understand your needs and how best we can support you.*

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

What kind of Pet do you have?*

DogCat

Pet's Name*

Pet's Age*

Breed*

Pet's sex*

Pet's weight if known

Color*

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.

YesNo

Would you like to desex your pet?*

YesNo

Please note: The Stay Foundation is unable to provide transport for your pet to and from this appointment. Are you able to arrange transport for your pet on the day of the appointment?*

YesNo

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

Has your pet 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

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.*

YesNo

Did you require assistance to complete 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 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.