-Vaccination Assistance-
Low Income/Low Cost Vaccination Assistance
First Name
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Last Name
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Address
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City
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State
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Zip
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Email Address
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Phone #
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Animal Name
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Species
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Species
Dog
Cat
Breed
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Abyssinian
Affenpinscher
Afghan Hound
African Grey
Airedale Terrier
Akbash
Akita
Alaskan Malamute
Amazon
American
American Bulldog
American Curl
American Eskimo Dog
American Fuzzy Lop
American Sable
American Shorthair
American Staffordshire Terrier
American Water Spaniel
American Wirehair
Anatolian Shepherd
Angora Rabbit
Appaloosa
Appenzell Mountain Dog
Applehead Siamese
Arabian
Australian Cattle Dog/Blue Heeler
Australian Kelpie
Australian Shepherd
Australian Terrier
Balinese
Basenji
Basset Hound
Beagle
Bearded Collie
Beauceron
Bedlington Terrier
Belgian Hare
Belgian Shepherd Dog Sheepdog
Belgian Shepherd Laekenois
Belgian Shepherd Malinois
Belgian Shepherd Tervuren
Bengal
Bernese Mountain Dog
Beveren
Bichon Frise
Birman
Black and Tan Coonhound
Black Labrador Retriever
Black Mouth Cur
Bloodhound
Bluetick Coonhound
Bobtail
Bombay
Border Collie
Border Terrier
Borzoi
Boston Terrier
Bouvier des Flanders
Boxer
Boykin Spaniel
Briard
Britannia Petite
British Shorthair
Brittany Spaniel
Brotogeris
Brussels Griffon
Budgie/Budgerigar
Bullmastiff
Bull Terrier
Bunny Rabbit
Burmese
Burmilla
Caique
Cairn Terrier
Calico
Californian
Canaan Dog
Canadian Hairless
Canary
Cane Corso Mastiff
Carolina Dog
Catahoula Leopard Dog
Cattle Dog
Cavalier King Charles Spaniel
Champagne DArgent
Chartreux
Checkered Giant
Chesapeake Bay Retriever
Chicken
Chihuahua
Chinchilla
Chinchilla
Chinchilla
Chinese Crested Dog
Chinese Foo Dog
Chocolate Labrador Retriever
Chorkie
Chow Chow
Cinnamon
Clumber Spaniel
Clydesdale
Cockapoo
Cockatiel
Cockatoo
Cocker Spaniel
Collie
Conure
Coonhound
Corgi
Cornish Rex
Coton de Tulear
Cow
Creme DArgent
Cymric
Dachshund
Dalmatian
Dandi Dinmont Terrier
Devon Rex
Doberman Pinscher
Dogo Argentino
Dogue de Bordeaux
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Donkey/Mule
Dove
Draft
Duck
Dutch
Dutch Shepherd
Dwarf
Dwarf Eared
Eclectus
Egyptian Mau
Emu
English Bulldog
English Cocker Spaniel
English Coonhound
English Lop
English Pointer
English Setter
English Shepherd
English Spot
English Springer Spaniel
English Toy Spaniel
Entlebucher
Eskimo Dog
Exotic Shorthair
Extra-Toes Cat (Hemingway Polydactyl)
Ferret
Field Spaniel
Fila Brasileiro
Finch
Finnish Lapphund
Finnish Spitz
Fish
Flat-coated Retriever
Flemish Giant
Florida White
Foxhound
Fox Terrier
French Bulldog
French-Lop
Gaited
Gecko
Gerbil
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Wirehaired Pointer
Glen of Imaal Terrier
Goat
Golden Retriever
Goose
Gordon Setter
Grade
Great Dane
Greater Swiss Mountain Dog
Great Pyrenees
Greyhound
Guinea fowl
Guinea Pig
Hamster
Harlequin
Havana
Havana
Havanese
Hedgehog
Heeler
Himalayan
Himalayan
Holland Lop
Hotot
Hound
Hovawart
Husky
Ibizan Hound
Iguana
Illyrian Sheepdog
Irish Setter
Irish Terrier
Irish Water Spaniel
Irish Wolfhound
Italian Greyhound
Italian Spinone
Jack Russell Terrier
Japanese Bobtail
Japanese Chin
Javanese
Jersey Wooly
Jindo
Kai Dog
Kakariki
Karelian Bear Dog
Keeshond
Kerry Blue Terrier
Kishu
Komondor
Korat
Kuvasz
Kyi Leo
Labrador Retriever
Lakeland Terrier
Lancashire Heeler
Leonberger
Lhasa Apso
Lilac
Lizard
Llama
Lop Eared
Lory/Lorikeet
Lovebird
Lowchen
Macaw
Maine Coon
Maltese
Manchester Terrier
Manx
Maremma Sheepdog
Mastiff
McNab
Miniature Pinscher
Mini-Lop
Mini Rex
Missouri Foxtrotter
Mixed Breed
Morgan
Mountain Cur
Mountain Dog
Mouse
Munchkin
Munsterlander
Mustang
Mynah
Neapolitan Mastiff
Netherland Dwarf
Newfoundland Dog
New Guinea Singing Dog
New Zealand
Norfolk Terrier
Norwegian Buhund
Norwegian Elkhound
Norwegian Forest Cat
Norwegian Lundehund
Norwich Terrier
Nova Scotia Duck-Tolling Retriever
Ocicat
Old English Sheepdog
Oriental Long Hair
Oriental Short Hair
Oriental Tabby
Ostrich
Otterhound
Paint/Pinto
Palomino
Palomino
Papillon
Parakeet (Other)
Parrotlet
Parrot (Other)
Paso Fino
Patterdale Terrier (Fell Terrier)
Peacock/Pea fowl
Pekingese
Percheron
Persian
Peruvian Inca Orchid
Peruvian Paso
Petit Basset Griffon Vendeen
Pharaoh Hound
Pheasant
Pigeon
Pig (Farm)
Pionus
Pit Bull Terrier
Pixie-Bob
Plott Hound
Poicephalus/Senegal
Pointer
Polish
Polish Lowland Sheepdog
Pomeranian
Pony
Poodle
Portugese Podengo
Portuguese Water Dog
Pot Bellied
Prairie Dog
Presa Canario
Pug
Puli
Pumi
Quaker Parakeet
Quarterhorse
Ragamuffin
Ragdoll
Rat
Rat Terrier
Redbone Coonhound
Retriever
Rex
Rhea
Rhinelander
Rhodesian Ridgeback
Ringneck/Psittacula
Rosella
Rottweiler
Russian Blue
Saddlebred
Saint Bernard St. Bernard
Saluki
Samoyed
Satin
Schipperke
Schnauzer
Scottish Deerhound
Scottish Fold
Scottish Terrier Scottie
Sealyham Terrier
Selkirk Rex
Setter
Shar Pei
Sheep
Sheep Dog
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shichions
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Silver
Silver Fox
Silver Marten
Singapura
Skunk
Skye Terrier
Sloughi
Smooth Fox Terrier
Snake
Snowshoe
Softbill (Other)
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Staffordshire Bull Terrier
Standardbred
Sugar Glider
Swan
Swedish Vallhund
Tabby
Tan
Tennessee Walker
Terrier
Thai Ridgeback
Thoroughbred
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tiger
Tonkinese
Tosa Inu
Toucan
Toy Fox Terrier
Treeing Walker Coonhound
Turkey
Turkish Angora
Turkish Van
Turtle
Vietnamese Pot Bellied
Vizsla
Warmblood
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Wheaten Terrier
Whippet
White German Shepherd
Wire-haired Pointing Griffon
Wirehaired Terrier
Xoloitzcuintle/Mexican Hairless
Yellow Labrador Retriever
Yorkshire Terrier Yorkie
Sex
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Male
Female
Weight
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Age
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Vet Clinic
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Green Hills
Sugar Creek
Annual Household Income (from IRS 1040), paystubs or awards SSI letter
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1040 with SSN# concealed
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PICTURES ARE REQUIRED IN ORDER TO RECEIVE A VOUCHER
Image of animal 1
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Image of animal or income
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I would like to have my dog/cat vaccinated through the low cost vaccination program. I understand that my application is not approved unless paypal invoice is paid within 2 weeks. Once approved, I will be required to make an appointment at the vet within 90 days of the issuance of the voucher.
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I understand that Saving Dogs Rescue does not take responsiblilty for any pesonal information provided on this form. I also understand if animal picture and income information is not provided, my form will not be processed.