Courtesy Spay/Neuter Application

Cast Aside To Survive (C.A.T.S.)
Courtesy Spay/Neuter Application

This is for Low-income households with documentation.
We do NOT supply diagnostic care, only spay/neuter and rabies vaccine.

* Indicates required field

Name *

First

Last

TODAYS DATE *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Number *

Cell Phone Number *

Email *

Birth Date mm/dd/yyyy *

Drivers license *

Name of pet *

Description (color(s) and Long or short haired) *

Age of pet *

Last Vaccines? *

Male or Female? *

If female, any Kittens currently? *

How many kittens currently? *

Born what date? (The CAT) *

Will you need a carrier to borrow? *

Do you receive ANY form of Social Services? We require a valid/current certification letter in order to qualify for free spay/neuter/vaccine services of pets. We do NOT need to see amount you receive, just the top portion with the date of the certification, your demographic information and the approval. Otherwise, please use the "Intake request form"
A current/valid certification of Section 8 housing is also acceptable.

In consideration of my acceptance of assuming ownership of the aforementioned cat(s), I hereby release and discharge, indemnify, defend and hold harmless, C.A.T.S., its Board of Directors, its volunteers, agents, members and any other individuals and entities contributing support, from any liability for damage to or loss of personal property, sickness, injury from whatever sources, legal entanglements, imprisonment, death, loss of money, etc. which may occur as a result of the surgical procedure to sterilize my cat(s). My participation is strictly voluntary and I assume all risks inherent and unforeseen. I have read and fully understand the terms and conditions of this release. I further understand that these provisions are binding and enforceable by law.

All personal information on this form shall be maintained for internal use only and shall not be distributed to external agencies except as required by law. I certify that my answers are true and complete to the best of my knowledge.

Certification Letter *

Max file size: 20MB

Electronic Signature *

Date *

Submit

Cast Aside To Survive (C.A.T.S.)
Courtesy Spay/Neuter Application

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Cast Aside To Survive (C.A.T.S.)
Courtesy Spay/Neuter Application