Border Animal Rescue, Inc. (BAR)
P.O. Box 3865, Sierra Vista, AZ 85636
Application for Reduced Cost Spay/Neuter
Please fill out this form so that we may evaluate your request. Program acceptance will be based solely upon the information you provide... All co-pays are required prior to service: Cash or credit card only...One pet per form, please... This service is available for a maximum of 2 pets per household per year... This assistance covers ONLY spay/neuter surgery, rabies vaccination (dogs and cats), and FVRCP vaccination (cats). Arrangement and payment for other vaccinations, parasite treatment, pain meds, or other services are the responsibility of the applicant/pet owner. Arrangements may be made for this form to be completed remotely with a BAR representative or online: However, the form MUST be signed prior to receiving services.
Please Note: Incomplete Applications Will Not Be Processed
Name
First Name
Last Name
Street Address (no PO boxes)
City, State, ZIP Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
Email address
example@example.com
Household information: Number under 18:
Number over 65:
Estimated Annual Income (total household income if spouse/significant other is in household)
Financial Information (Check all that apply or insert number as applicable)
Number in Household (insert number)
Unemployed
Social Security is ONLY source of Income
Food Stamps
AHCCCS
On Disability
Low Income
Military
Multiple Animals (Insert Number)
Single Parent
Student
Spouse or equivalent in same household
Any Other Relevant Information You Wish to Provide:
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Your Pet's Information
Name of Pet
Dog
Cat
Male
Female
Breed
Color/markings
Age
What Other Pets are in your household? Are they spayed/neutered?
Other
Pet Name
age and breed
Other
Pet Name
age and breed
Other
Pet Name
age and breed
spayed/neutered
Yes
No
spayed/neutered
Yes
No
spayed/neutered
Yes
No
Please initial here
to indicate you understand there is a co-pay of $50.00 per cat and $70.00 per dog and that co-pays are due prior to surgery. For credit card payments, a service charge of $2 per pet is added.
I can provide an additional donation of
to help pay for these services. (Border Animal Rescue thanks you!)
By signing below, I certify that the pet to receive surgery is my own private pet, that the pet is not for resale, part of a business or business arrangement, or to be adopted out, and will remain in my home. Should my situation change, I will contact Border Animal Rescue at (520) 432-7964 for guidance. I further certify that all information provided is true at the time of signature.
Signature
Date
Date; 00/00/0000 format
BAR Representative Signature
Date
Date; 00/00/0000 format
Border Animal Rescue is a non-profit, all-volunteer group fully supported by grants and donations.
Border Animal Rescue, P.O. Box 3865, Sierra Vista, AZ 85636 Voicemail line: 520-432-7964 Email: borderanimalrescue@gmail.com www.borderanimalrescue.org
2025
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