SNIP Application – Ketchikan Humane Society

Low Cost Spay-Neuter Incentive Program (SNIP) Application

You must be over 18 years of age to apply.
Name*

First NameLast Name
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
YesNo
If YES - please note when
Pet Name (One per application)*
Pet Species*
FemaleMaleUndetermined
Pet Age*
FOR DOGS - Pet Weight
Food StampsMedicaid / Denali Kid CareSection 8 Public HousingSocial Security DisabilityWomen, Infants, and Children (WIC)
Government Program Supporting Documentation

Cancelof
Financial Hardship

Our low-cost spay-neuter program is based, in part, on financial need. If you are not participating in a government assistance program please provide a brief statement on why you are seeking financial assistance with the surgery.
Statement
StrayFriendOther
IF OTHER - Please explain:
How much can you afford to pay?*
I agree to the statement above
Today's Date*

MonthDayYear
Date
Certification statement*
Should be Empty:

Financial Hardship