Sterilization Update/Deposit Refund Request


Instructions Please complete the following short form to tell us whether your dog has been spayed or neutered.
Contact Information
First Name * Enter your first name
Last Name * Enter your Last Name
Address * Enter your mailing address.
City * Enter your city.
State * Select your state.
Zip Code Enter you zip code.
Enter your phone number * Please enter your phone number so we can update our records.
Email * Use format: user@domain.com
Enter the dog's HADR name *
Has your dog been spayed or neutered? *
Reason for Not Spaying or Neutering
Why hasn't the dog been sterilized? *	Medical Issue Pending Heat Cycle Just haven't done it yet Dog is too young My Dog Died I don't want to spay or neuter Other
Please explain: *
Please explain why you aren't ready to alter your dog. *
When did your dog die? *
When do you plan to spay or neuter your dog? *
Proof of Sterilization
When was the dog spayed or neutered? *
Veterinarian's Name *
Veterinarian's Phone Number *
Proof of Sterilization (File type: JPG/Photo) * Take a picture of the vet receipt or record showing that your dog was altered. Be sure it includes the date and the animal hospital where it was done.
Add more documents? * Select Yes if you need to add more documents.
Additional Document (File type: JPG/Photo) *
Enter any comments
Signature By submitting this request, I certify that the above information is true and correct under the penalties of perjury. I understand that pursuant to Section 24. STERILIZATION STATUS, I must use this form to request a refund and proof of sterilization, my deposit refund request must be completed within 30 days of sterilzation, and that I must complete the sterilization surgery by the date specified. Otherwise, the deposit will be considered a donation to HADR. If you are using a phone or tablet to complete this application, simply sign your name below. If you are using a computer, use your mouse to write your name below.
Signature * Sign Here
Click submit once. It may take up to 30 seconds for the screen to change. Do not click submit more than once.
Thank You! Please click the Submit button below. ⬇️

Sterilization Update/Deposit Refund Request

Instructions

Contact Information

Reason for Not Spaying or Neutering

Proof of Sterilization

Signature

Thank You!

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