CCC Dog App by fL3DlI

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									               Application for Low Cost Spay/Neuter
Name:_______________________________________________________________                  Cat Care Coalition

Address:_________________________________________________________________

Telephone (home)__________________________________________________________________

Telephone (work/cell)_______________________________________________________________

Email: ________________________________________________

Number of Family members: Under 21_____ 21-50_____ 51-65 _____ Over 65_____

Total Annual Income--- (before taxes) of all wage earners in the household ___________________

If any household members are currently receiving benefits from any entitlement programs such as
Public Assistance, SSI, Medicaid, HEAP, Food Stamps, or Family Health Plus/Child Health Plus you
are qualified and you will need only to submit a copy of your benefit card or award letter.

 YOU MUST PROVIDE A COPY OF THE MOST RECENT W-2 FORM, PAY STUB OR
 BENEFIT CARD AS VERIFICATION OF INCOME OR BENEFITS FOR ALL ADULT
  HOUSEHOLD MEMBERS. THIS WILL BE KEPT WITH YOUR APPLICATION.
    ►APPLICATIONS WITHOUT THIS INFORMATION WILL NOT BE
                      CONSIDERED◄


Animal(s) Requiring Surgery Female Dog(s) __________ Age(s) ______ Weight ____________
                            Male Dog(s) ____________ Age(s) ______ Weight _____________

Number of animals in household____________ Number already spayed/neutered____________

Name and phone number of your current veterinarian____________________________________


All dogs will receive a distemper vaccination, a rabies vaccination valid for one year, and a
heartworm test in addition to spay/neuter surgery. The charge for male dogs will be $80. For
female dogs under 60 lbs., the charge will be $120. The charge for female dogs over 60 lbs. will be
determined on a case by case basis depending on actual weight and age. If your dog has been
vaccinated against rabies in the past and you can provide verification, your dog will get a rabies
vaccination that will be valid for 3 years. Please provide copies of records for any treatment your
pet has had within the last 3 years.


Applicant’s Signature _________________________________________________ Date___________

       Cat Care Coalition c/o Central Veterinary Hospital 388 Central Ave Albany NY 12206
                  Website: www.catcarecoalition.com        Phone: 518 466 8484
Dear Pet Owner,

        Thank you for deciding to have your dog altered. The numbers of unwanted pets in this country
is huge, and you are doing the right thing by making this decision. Spaying/neutering your pet not only
keeps them from reproducing, it also decreases some unwanted behaviors, including wandering,
aggression and urine marking and extends life span.
Please read the following information on our Spay/Neuter Program:

      Your application CANNOT be processed without proof of income or benefits for ALL
       adults in the household. Make sure you include it when your application is submitted. For
       a single person household, the maximum annual income allowed is $39,550 with an additional
       $5650 for each additional household member.

      Once your application has been approved, you will be contacted with a date to bring your pet to
       the clinic for surgery

      We usually have a large backlog of applications, and will schedule the surgery as soon as
       possible. Currently all surgeries are being done at Central Veterinary Hospital, 388 Central
       Avenue, Albany or Rotterdam Veterinary Hospital, 2806 Guilderland Ave, Schenectady.

      Your pet must not have any food past midnight the night before the surgery. If you can’t isolate
       the cat from other pets in the household, remove food for ALL pets.

      You must pay for the surgery (and any still needed vaccinations and testing) in CASH on
       the morning of the surgery, when you bring the animal in. We are not able to accept
       checks or credit card payments.

      Our veterinarian will give your cat an examination prior to surgery. If the dog isn’t healthy, no
       surgery will be performed and you may need to take it to your regular veterinarian for treatment
       and then reschedule surgery.

      Your dog will be tested for heartworm, a potentially serious illnesses. If your dog tests positive,
       you will be called before the surgery is done.

      You will need to provide a phone number where you can be reached at all times on the day of
       surgery.

                              Sincerely,

                              The Cat Care Coalition

								
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