Application for Domestic Spay-Neuter

Application Process:

● Proof of low-income and address is REQUIRED. Your application will be rejected if proof is not emailed to spay-neuter@ohlonehumanesociety.org
● Resident may be contacted regarding co-pay for vet services.

● Do not make an appointment until you have the voucher.

Email address *

Ohlone Humane Society, Inc.

Available only to Low-Income Residents of Fremont, Newark & Union City.

THIS IS NOT A SPAY-NEUTER VOUCHER

Applicant Name *

Best email *

How did you learn of our program? *

Animal Name *

Animal Species *

Dog

Cat

Rabbit

Animal Description (breed, color) *

Animal Gender *

Animal Age *

Animal Weight *

Address, City, Zip *

Phone *

I qualify for low-income programs and can verify I belong to the following: *

Cal-SNAP

PGE Care

Cal-Fresh

Section 8 Housing

WIC

REQUIRED: I have EMAILED documents to spay-neuter@ohlonehumanesociety.org to verify my LOW INCOME program status and PROOF OF RESIDENCY in Fremont, Newark, or Union City. (Application will be REJECTED if documentation is not provided.)

Responsible Party Co-Pay : I understand my co-pay will be negotiated with an OHS representative and is to be paid in cash directly to veterinary clinic on the day of surgery *

I release Ohlone Humane Society (OHS) from all responsibility arising from the spay-neuter surgery and any/all resultant complications that arise from handling and dealing with my animal. I take full responsibility for my animal. *

I understand that a veterinarian of OHS's choosing will perform the spay-neuter surgery and that any spay or neuter performed by a veterinarian other than the one listed on my voucher will be completely at my expense. I must wait to have a voucher in hand before an appointment for surgery can be made. *

I understand the voucher program only covers the cost of surgery after the copay is satisfied and that I am responsible for any/ all additional expenses to be paid directly to the veterinary clinic prior to surgery. *

I certify that I am at least 18 years of age. *

I have read and understand and accept all terms set forth in this application and verify that all of the information is true. Submitting this application serves as my electronic signature .By submitting this form, I consent to the use of my contact information by and to receive emails from representatives of Ohlone Humane Society. I understand I can revoke my consent to receive emails at any time by emailing privacy@ohlonehumanesociety.org.

Date Submitted *

Application for Domestic Spay-Neuter Voucher

Application for Domestic Spay-Neuter Voucher

Available only to Low-Income Residents of Fremont, Newark & Union City.

THIS IS NOT A SPAY-NEUTER VOUCHER

Application for Domestic Spay-Neuter Voucher