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 *
Last Name *
Address *
City *
State *
Zip Code
Enter your phone number *
Email *
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) *
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 *
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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