Application for Low Cost Spay 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 Cat(s) __________    Age(s) ______________
                                           Male Cat(s) ____________    Age(s) ______________

Number of animals in household____________ Number already spayed/neutered____________

Name and phone number of your current veterinarian____________________________________


Your pet will receive a distemper vaccination, a rabies vaccination valid for one year, and
spay/neuter surgery for $60. If you would like your cat tested for Feline AIDS and Leukemia,
there will be an additional $15 charge. If your cat has been vaccinated against rabies in the past
and you can provide verification, your cat 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 cat altered. The numbers of unwanted cats 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 at 388 Central
       Avenue in Albany.

      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 cat 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.

      If you choose to pay the additional $15, you may have your cat tested for Feline leukemia and
       Feline AIDS, both potentially serious illnesses. If your cat tests positive, you will be called
       before the surgery is done.

      Each cat must be in a carrier. If you don’t have one, you can purchase one from the Coalition
       for $5 before bringing your cat into the clinic for surgery.

      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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