River Valley Humane Society | Boyer Zach Spay/Neuter Assistance Pilot Program Application

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County of Residence*

Johnson CountyOther

If you selected "other" above, please explain why you are applying as a resident outside of Johnson County, AR

Phone Number*

Ex: (479)-754-4200

Your Email Address*

example@example.com

Do you acknowledge that all Spay/Neuter Assistance communication will be via email from outreach@needypawsanimalshelter.org (no phone calls, please)?*

Type your answer above

Number of Adults in your Household:*

Please include all adults living at your address

Number of Children in your Household:*

Please include all adults living at your address

What is Your Annual Household Income?*

How many cats and/or dogs are in your household?*

This includes all cats and dogs that reside at your address, regardless of ownership

Are all of your cats and/or dogs up to date on vaccines?*

YesNoOther

If you selected "Other" above, please explain or put "N/A" if this does not apply.

If you selected "Other" above and have no explanation, your application may be waitlisted or denied

Aside from the animal described in this application, are all of your other cats and/or dogs spayed/neutered?*

YesNoOther

If you selected "Other" above, please explain or put "N/A" if this does not apply.

If you selected "Other" above and have no explanation, your application may be waitlisted or denied

This voucher application is for:*

Female Canine/Dog SpayMale Canine/Dog NeuterFemale Feline/Cat SpayMale Feline/Cat Neuter

What is your pet's name and age?*

What is your pet's breed, color, size, etc.*

Upload a Photo ID, Utility Bill, or other Proof of Residency in Johnson County, Arkansas*

Proof of Residency must be dated within 30 days of this application

Upload Proof of ANNUAL Income showing the INCOME for ALL ADULTS in your household (W2s or other wage statements, IRS Form 1099s, tax filings, bank statements demonstrating three months' regular income, SSA Benefit Letters). Screenshots will NOT be accepted, please submit photos or scanned images of paperwork. *

Upload a photo of the cat/dog/kitten/puppy this Voucher Application is for:*

1) Approved applicants will be invoiced via email for a non-refundable deposit to reserve your Spay/Neuter Voucher. This deposit will be paid to the vet you have chosen after your appointment is complete.

2) Vouchers will not be issued without a paid, non-refundable deposit. If paying by check, please allow up to 14 business days before inquiring about your Voucher.

3) Non-refundable Deposit Amounts (what you are required to pay) paid to River Valley Humane Society by the Voucher Recipient upon Approval:

Dog Spay: $50
Dog Neuter: $40
Cat Spay: $30
Cat Neuter: $20

You may choose from the following veterinarians in Clarksville, AR, to schedule your spay/neuter appointment. These are the only clinics available for the Spay/Neuter Pilot Program:

Tri-County Veterinary Services - (479) 754-9090
Clarksville Veterinary Clinic - (479) 754-6074
Parker Animal Clinic - (479) 754-5656

After you submit payment for your non-refundable deposit, you will receive a confirmation of your voucher via email. This confirmation will include your name, your pet's name, the voucher number, and specific information regarding the vet appointment, financial responsibility, etc.

Only the person applying for the voucher can redeem the voucher at the vet appointment.

Vouchers will expire 45 days after they are approved and we will not allow any extensions or transfers of the vouchers at this time. Vouchers will only cover the cost of the spay/neuter surgery. You are responsible for any exam fees, testing, or additional costs that may arise. Please contact your chosen vet for a full cost estimate.

Some clinics may have pre-surgery exam requirements that are not covered by this voucher. I understand that I am responsible for discussing any spay/neuter surgery appointments and fees with my vet.*

Type "I agree"

This voucher application is for the animal listed on this application and only covers the basic spay/neuter surgery portion of the final vet bill. I am aware that I will be required to pay any additional costs owed after the Spay/Neuter Voucher amount.*

Type "I agree"

If approved, I will receive an invoice for the NON-REFUNDABLE DEPOSIT and will pay that upon receipt. If the NON-REFUNDABLE invoice is unpaid, I will not receive any further information and will not be authorized to receive a Spay/Neuter Voucher discount.*

Type "I agree"

I understand that Spay/Neuter vouchers will expire 45 days after they are approved and there are NO extensions or transfers of the vouchers at this time.*

Type "I agree"

Which Veterinary Clinic will you be using to schedule your pet's appointment?*

Tri-County Veterinary ServicesClarksville Veterinary ClinicParker Animal Clinic

Voucher applications may take up to 30 days for processing. You will receive your application status ONLY through email from outreach@needypawsanimalshelter.org. No information will be given by phone or in-person.*

Type "I agree"

Questions or Comments? Submit below or email info@needypawsanimalshelter.org

River Valley Humane Society Boyer Zach Spay/Neuter Assistance Pilot Program Application

Thank you for your interest in the Boyer Zach Spay/Neuter Assistance Program!

Questions?

Program Details