Spay/Neuter Application

The Coffee County Humane Society’s program of assistance for spay or neuter of pets is available to individuals and families with income of no more than 150% of the Federal Guidelines Poverty Level, which is about $45,000 per year for a family of four. You must provide proof of assistance or income, such as a pay stub, bank statement, entitlement letter, or copy of an EBT card. All family income must be included. A small co-payment to the vet is needed. All information is kept confidential.

Application for Spay/Neuter Assistance

First Name *
Last Name *
Home Address *
City *
State *
County *
Zip Code *
Phone Number *
E-Mail * This will be the primary contact method, unless you've messaged us through Facebook.
Number of Adults in Household *
Number of Children in Household * If no children in household, please put none or 0.
Total MONTHLY Household Income * Please include all sources of income you recieve in a month.
What public assistance do you receive? *
Proof of Income Please provide a photo of proof of income or assistance (pay stub, bank statement, entitlement letter, or copy of an EBT card). Take a photo, click "choose file" and select photo to upload.
Has your animal ever been seen by a vet? *	NoYes
When was your pet's last rabies vaccination? * If pet has not recieved a rabies vaccine, please put "none"
Which vet do you take your animals to?
Veterinary's Phone Number
Pet Name
Cat or Dog? *	Cat Dog
What color is the animal? *
Is your pet male or female? *	Male Female Unknown
Age of Pet
Weight of Pet Or best guess of their weight
Do you need help with another animal? *	NoYes
Pet Name
What color is the animal? *
Cat or Dog? *	Cat Dog
Is your pet male or female? *	Male Female Unknown
Age of Pet
Weight of Pet
When was this pet's last rabies vaccination? * If pet has not recieved a rabies vaccine, please put "none"
How did you hear about our program?
Did this pet come from another rescue? *	NoYes
Which rescue organization? *
Additional Comments Please let us know if there is anything else we should know. For example, if you have an animal that is pregnant, in heat, or has already given birth, please provide additional information.