Application for Spay/Neuter Assistance

This program is limited to Blount County, Alabama residents only. Please be prepared to provide proof of residency.

Thank you for your interest in getting your pet(s) fixed. There are too many pets without homes in Blount County and by getting your pet(s) fixed you will help to reduce the thousands that suffer and die each year. Not only will you be helping with the overpopulation problem but you will have a healthier and easier pet to live with.  It is a proven fact that "fixed" pets do not have the rate of uterine and mammary cancer that non-"fixed" animals have.  Males are less aggressive and less likely to roam and simply make better pets.

Funds are limited and we want to help as many pets as possible. If you can afford to pay at least some of the cost of the surgery, please do so and allow us to provide free spay/neuters to those truly in financial need. We request a contribution of $25 from those who can afford to help with the costs. If you cannot afford to contribute any amount, it will be done for free. If you need help with transportation, that will be arranged.

Can you afford to pay part of the cost of the surgery?    

Please indicate the reasons you are requesting free spay/neuter (check all that apply):

  Unemployed

  Student

  Senior Citizen

  Medical Problem

  Disability

  SSI

  Receiving Public Assistance

  Receiving Medicaid

 

  Other (please explain):

PERSONAL INFORMATION

Name:

Home Phone:

Work Phone:

Physical Address (no PO boxes):

City:

State:

Zip:

Email:

 

PET INFORMATION

My pet's name:         Age:  

Breed:        

Has this animal ever been to a vet?    

Do you have other unfixed animals?       If so, how many?    

Do you need help getting them spayed or neutered?      


 

AFFIRMATION

By submitting this form I hereby certify that the information I have provided is true and correct and I have not omitted any information that will make my application false or misleading. I will not hold Crossing Paths Animal Rescue, nor any volunteer, officer, director nor any veterinarian, employee or volunteer liable for any complications or death resulting from the medical procedure for which I am applying.

Electronic Signature (please type your name). Must be 18 years or older to sign: