Barks & Whiskers Without Litters Grant Application

Barks & Whiskers Without Litters Grant Application

Spay/Neuter Grant through Rocky & The Bark Bunch Rescue - Grant funded by Walmart Sprk Grants and Private Donations
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Pet Information
Pet Name
Are you the legal owner of the pet?
Species
Age (in years)
Weight (in pounds)
Is your pet up to date on vaccines?
Is your pet have an up to date rabies?
Current Veterinarian
Residency Verification
Upload Valid ID and Utility Bill (Rockingham County Residency Proof)

Cancelof
Eligibility Information (Select one and provide documentation)

Other
Other Reason (please explain)
Household Information
Number of adults in household
Number of children in household
Number of pets in household
Are the pets in household spayed or neutered?
If no, reason why pets are unaltered
Commitment and Understanding
Check here to acknowledge that you will be responsible for all amounts billed by the veterinarian above the amount of the grant for services rendered.
Commitment Statement

I understand this grant is intended to support the health and well-being of my pet. I agree to ensure my pet is properly cared for, including spay/neuter, vaccinations, and a safe, loving environment.
Grants will be awarded based on demonstrated financial need to ensure assistance is directed to those who need it most. Approved applicants will receive funding in tiered amounts of $50/$75/$100.

Award amounts will be determined based on individual circumstances, including financial eligibility and level of need. Funds will be applied directly toward approved veterinary services, such as spay and neuter procedures.
Signature
Should be Empty:

Barks & Whiskers Without Litters Grant Application

Pet Information

Residency Verification

Household Information

Commitment and Understanding