Spay-Neuter Application

Spay\Neuter Application

(Click here to download a pdf copy to print and mail)

Contact Information for the Cat Owner

Date
Name
Street Address
City  & Postal Code
Home Phone
Cell Phone
E-Mail Address

I am applying for Spay Day assistance in the following category:

Student (please attach a copy of your student ID)
Fixed or Low Income (please attach a cop of your 2010 T4 or proof of income)
I have recently taken in a stray cat and require assistance(please explain circumstances in the notes area below)

Contribution

Are you able to contribute any amount to help with the spay\neuter of your cat?  Yes ___     No ____If yes, how much?

Cat Information

Name of cat:
Age of cat:                                                    Note: Cat must be at least 6 months of age
Cat is:  Male ____          Female ____              Does your cat go outside: Yes ___       No ____
Has this cat had vaccinations:  Yes ____      No ____
Has this cat previously been to a veterinarian:   Yes ____          No ____
If yes, what for?
Does this cat have any known health problems?  Yes ____    No _________
If yes, provide details:

Transportation & Assistance

Do you have a vehicle?  Yes ___    No ___
Will you require transportation assistance to take your cat to the clinic to be spayed or neutered?Yes ____         No ____
Do you have a cat carrier (cage) for transportation of your cat to the veterinarian?Yes ____         No ____

Additional information

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete.
Signature:

Limitations

Note: Spay Day is an initiative of a not-for-profit volunteer organization and there will be a limited number of cats that can be assisted. Applications will be processed on a “first-come first-served” basis with priority given to greatest need. You will only be contacted if we are able to assist your cat.

Submit this form:

By mail to:Attention: Spay Day

40 Lier Ridge, Halifax, N.S. B3P 0C7

OR

By email (Copy and Past this page) into your email (fill in the form) and send it to: spaydaynovascotia@gmail.com

Reminder: to include a copy of your student ID or proof of income