SNIP Application

SNIP APPLICATION

Gander and Area SPCA
36 McCurdy Dr.
Gander, NL A1V 1A2
709-651-3002
ganderandareaspca@outlook.com

The SNIP program is funded to provide assistance to qualifying individuals in the Gander area, with the cost of spaying or neutering animals in their care. The surgery is to be preformed at the Gander Vet Clinic after your application has been approved and you have paid the required fee.

Your application will be reviewed by a staff member of the Gander and Area SPCA, all information we receive is strictly kept confidential and will not be shared with any outside parties. Once your application is reviewed, you will be notified if your application is approved, if we require further information, or if your application has been denied.

If approved and placed on a wait list, you will be notified once we are able to provide assistance. Your fee for the spay/neuter would be as follows:

• $100 for a male cat
• $150 for a female cat
• $150 for a male dog
• $150 for a female dog

To qualify for assistance you must meet one of the following criteria:

• Have a combined family net income of $30,000 or less.
• Be a single parent with a net income of $30,000 or less.
• Be single (living on your own with no other means of support) and have a net income of $20,000 or less.
• Be 65 years of age or older and receiving the Guaranteed Income Supplement. If you fall outside of the criteria, you may be considered by “special circumstances”, providing you prove with documentation, your need for assistance.

Contact Information: Please ensure you have provided reliable contact information. We need to be able to contact you for follow up questions and/or application approval.
First Name: *
Last Name: *
Names of ALL ADULTS (18+) living in your household: *
Occupations of all adults in the home: *
Names and ages of children under 18 in your home: *
Street Address: *
Town/City: *
Province: *
Postal Code: *
Email Address: *
Phone Number: *
List ALL of the currents pets in your home.
Pet One:
Name:
Type Of Animal:
Sex:	Select One Male Female
Is this pet fixed?	Select One Yes No
Pet Two:
Name:
Type of Animal?
Sex:	Select One Male Female
Is this pet fixed?	Select One Yes No
Pet 3:
Name:
Type of animal?
Sex:	Select One Male Female
Is this pet fixed?	Select One Yes No
Pet 4:
Name:
Type of animal?
Sex:	Select One Male Female
Is this pet fixed?	Select One Yes No
Information of Pet You Are Applying For:
Pet's Name: *
Pet's Age: *
Species *	Please Select Cat Dog
Breed: *
Sex: *	Please Select Male Female
Colour: *
Fur Length: *	Please Select Short Medium Long
Approx Weight: *
Please upload a Photo of your pet *
Does this pet have any medical issues?: *	Please Select Yes No
If yes, what issues does he/she have?:
Where did you obtain your pet?: *
Has your pet had or fathered any litters?: *	Please Select Yes No
If yes, how many litters?: *
If yes, how many offspring were produced?: *
What did you do with the offspring?: *
Other Questions:
Please supply TWO references who can verify your pet and need for assistance; both have to be non family members (co-workers, friends etc.) Reference 1:
Name: *
Relationship to the reference: *
Phone number: *
Reference 2:
Name: *
Relationship to the reference: *
Phone number: *
Do you have a pet carrier or a leash to properly transport your pet?: *	Please Select Yes No
Are you able to get your pet to and from the Gander Vet Clinic?: *	Please Select Yes No
How did you hear about our low-income spay/neuter assistance program?: *
Have you had any other animals previously spayed/neutered under this program?: *	Please Select Yes No
If yes, which animal(s) and when?:
Please make sure your notice of assessment can be clearly read before uploading.
Notice of Assessment upload *
Image upload
Once your application is assessed, a staff member will contact you. If approved you will be provided with instructions as how to pay your portion of the spay/neuter and when you can proceed to book your appointment. Your fee is non-negotiable. We urge you to start saving and/or fundraising to ensure you are able to pay your fee.
By signing below, I hereby certify that I have thoroughly read this application and that the information I have stated is true to the best of my knowledge and that the above named animal is owned by me personally. I understand there is a fee I must pay upon approval, before being placed on the waiting list. I understand that the Gander and Area SPCA will only consider my application for the pet listed and that any other pets I have may not be considered eligible and any pet(s) I obtain hereafter will not be qualified to be spayed/neutered under the SNIP Program.
*	Do you agree to the terms stated above?:
Signature of Applicant	Clear
Date: *
SURGERY AGREEMENT AND WAIVER I, being responsible for the pet described above, have the authority to grant the Gander and Area SPCA, Incorporated, hereinafter known as the “SPCA”, the Gander Veterinary Clinic and their representatives, my consent to receive, treat and/or operate on this pet. I understand that while all procedures are to be done to the best abilities of the staff, no assurance or guarantee has been made of the results of any surgery or treatment, and that the risks and probabilities of complications exist in any surgical or medical treatment. I consent to the administration of anesthetics and/or other medications as may be deemed necessary by the veterinarian. I will not hold the SPCA, its staff, nor the attending veterinarian and their staff responsible, should my pet contract any disease whatsoever. If I fail to give the required 24 hour cancellation notice or if I fail to show up to my scheduled appointment, my application approval may become revoked and a new appointment can only be made with approval of the SPCA. I will carefully follow pre-surgery and post-surgery instructions, including keeping my pet inside if a cat or on a leash and watched if a dog, prior to surgery and a period afterwards for recovery. I will transport my pet safely and securely, in a pet carrier or on a secure leash. I understand that the appointment covered by the SPCA, is ONLY for the pre-surgery blood work and the spay/neuter. I understand that any further costs that may arise, is solely my responsibility and the SPCA will not be responsible covering any of this cost. I understand that if my pet is pregnant at the time of surgery, the litter will be aborted. I understand that appointments for nursing mothers may only be made 6 weeks after the litter is weaned. I HEREBY CERTIFY THAT I HAVE READ AND UNDERSTAND THE ABOVE AGREEMENT AND WILL COMPLY TO THE BEST OF MY ABILITY.
*	Do you agree to the terms stated above?:
Signature of Applicant	Clear
Date: *
FOR SPCA OFFICE USE ONLY Date Recieved: Approved? Yes No Meet Income Cut-Off? Yes No Special Circumstances? Fee Amount Required: Fee Paid? Yes No Date of Payment: Surgery Date: Notes: