Clone of 2025 SNAP Application

CANINE SPAY/NEUTER ASSISTANCE PROGRAM (SNAP) APPLICATION

SPAY/NEUTER ASSISTANCE PROGRAM (SNAP) APPLICATION
A non-refundable $100 deposit is required with each application submission.

This will be applied toward the total cost of the service selected.

All cancelled appointments must be rescheduled within 6 months of application date. If not rescheduled, a new application and new deposit are required.

CURRENTLY ALL CANINE SNAP APPLICATIONS WILL BE PROCESSED AS VOUCHERS TO PARTICIPATING VETERINARIANS - Second Chance's inhouse schedule is set through the end of 2026.
Date of Application:

MonthDayYear
Information about OWNER:
Name

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

Zip Code
City
State

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
E-mail
Information about your DOG:
Due to the need for extra monitoring and/or alternative anesthetic protocols, brachycephalic breeds, cryptorchid males, and female dogs over 50 pounds will need to utilize our voucher program instead of our inhouse spay/neuter clinic.

We reserve the right to refuse vaccination or surgery if an animal has health issues found on examination that make surgery or vaccination unsafe or if your animal’s behavior presents a danger to our staff. Remember that your deposit is non-refundable so be sure not to submit an application for any of the above.
Name
Is your pet Male or Female?
Age of Pet:
What is their breed?
How much do they weigh?
What color is their coat?
How did you acquire your pet?
How long have you had your pet?
Does your pet have any known medical conditions, history of seizures, heart murmur, problems with anesthesia, or allergies?
Has your dog ever tested POSITIVE for a tick-borne disease? If YES, please describe.
Name of Veterinarian
ALL dogs must have the rabies vaccine as required by state law. Proof of vaccination must be provided at the time of the appointment. If your dog is not up-to-date, the rabies vaccine will be administered for an additional fee.
Select Services:
Applicant Signature:
I certify that the information on this application is accurate.
Date

MonthDayYear
NON-REFUNDABLE DEPOSIT
prevnext( X )
Dog: Non-refundable deposit$100.00

Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

CANINE SPAY/NEUTER ASSISTANCE PROGRAM (SNAP) APPLICATION

Information about OWNER:

Information about your DOG:

Applicant Signature:

NON-REFUNDABLE DEPOSIT*

Payment Methods

NON-REFUNDABLE DEPOSIT