Spay Neuter Assistance

Information

Voucher__________ Expires__________
Lycoming County SPCA
Application for Spay/Neuter Assistance
***ONLY VALID IN LYCOMING COUNTY***
**VOID IF INCOMPLETE**
Date_____/_____/_____

Name______________________________________________________________________________________________________

Address____________________________________________________________________________________________________

City_________________________State_________________________Zip_________________________County_______________

Day time phone(_____)________-____________

Please tell us about the pet you need assistance for.

„Q Cat „Q Dog „Q Male „Q Female If a cat, „Q Short Hair „Q Medium Hair „Q Long Hair

Breed_________________________ Age__________ Color_________________ Pet¡¦s Name___________________

How did you acquire your pet? „Q This shelter „Q Pet store „Q Gift „Q Stray „Q Other

How many litters has your pet had? „Q 0 „Q 1-2 „Q 3-4 „Q 5+

Who is your veterinarian?______________________________________________________________________________

What is the date of your pet¡¦s last shots?____________________________

If your pet does not have its shots, do you agree to get your pet its shots? „Q Yes „Q No

How much can you contribute towards the Spaying/Neutering of your pet? „Q $0 „Q $25 „Q $50 „Q $75 „Q $100
„Q $125 „Q $150
How many other pets do you have in your home?__________________________________________________________

How many of your other pets are already spayed or neutered?_______________________________________________


********************READ BELOW AND DETACH FOR YOUR RECORDS********************
The Lycoming County SPCA spay neuter assistance program is available for low income individuals. In order to qualify for this program you must show proof of low income. This proof may include your most recent tax return, government assistance such as Medicaid, SSI, food stamps, WIC, Section 8 housing, school lunch program, or unemployment assistance. If you are not low income and need assistance because the animal was a stray, we will supply you with a $20 voucher. You will not need to show proof of income.
„« Please complete the application and bring it to the SPCA with your proof of low income.
„« Incomplete applications will delay your assistance.
„« Because of limited funding we cannot guarantee all applications will be approved. Once approved, a staff member will call you to pick up your voucher. We cannot supply vouchers for animals that have already been spayed or neutered. Please do not schedule your pet¡¦s surgery until you are assured of receiving a voucher.
„« If you find yourself with too many pets to care for please consider surrendering them to the SPCA for adoption. It would greatly reduce the burden on you for caring for them.
„« The SPCA will give low income individuals a voucher of $50 toward a neuter, or $75 toward a spay.
„« When you are called to pick up your voucher you should make your appointment with your veterinarian because there is an expiration date on the voucher.
„« You must sign the voucher before giving it to your veterinarian. He or she will reduce your bill by the amount of the voucher. You will need to pay the difference.
Please keep for your records: Date of application to the SPCA______________________________________