KC Rescue’s Spay Neuter Assistance Program is only available for qualified low-income families. Financial aid is available for spay/neuter surgeries and tattoo identification only. Due to the nature of our program we need to ask our applicants the following questions:

 

 

Cat Owner Information:

Complete all information!

The more complete your information is the quicker we can assist you.

Your name

Phone #

 

Date

What is your approximate household income per year?  (please circle)

 

    Less than $9,999       $10,000 to $19,999       $20,000 to $29,999       $30,000 to $39,999

 

$40,000 to $49,999       $50,000 to $59,999       $60,000 to $69,999

 

What is the source of your income?

 

 

How many adults in your home work?

 

How many people in your household?

Adults (18 or older) _____   Children (Under 18 of age) _____

 

 

How did you hear about our program?

 

Do you own or rent your home?

 

 

How many cats do you need fixed? (no limit)

 

 

Do you have a family veterinarian?

 

 

If you have a veterinarian, how many times per year do you visit the clinic? (please circle)

 

0 times or in the case of a serious emergency  1 time per year   2 times per year   More than 2 times

 

 

Have any of your cats received shots? No or Yes, (please circle) In the last   1-2 yrs,    2-3 yrs,    over 3 yrs.

 

(your cat can still get fixed if it does not have shots)

 

Have any of your female cats had litters of kittens?     If so, how many litters?

 

 

How much money can you contribute for the spay or neuter of your cats?     $  _____ per cat

 

 

What would be the best time to call you and discuss the information in your application?

 

 

Cat Owner Information:     Please Print

Name:

 

Address:

 

 

 

City:

 

Postal Code

Home phone:

 

Cell:

Work:

Email address:

 

 

 

Cat # 1

Name of cat #1:

 

Age:

Male or Female?

 

Hair Length: (short, medium or long?)

Color/Description of cat:

 

 

Cat #2

 

Name of cat #2:

 

Age:

Male or Female?

 

Hair Length: (short, medium or long?)

 

Color/Description of cat:

 

 

 

Cat #3

 

Name of cat #3

 

Age:

Male or Female?

 

Hair Length: (short, medium or long?)

 

Color/Description of cat:

 

 

SURGERY AGREEMENT AND WAIVER

 

 

·        I, being responsible for the cat(s) described above, have the authority to grant KC’s veterinarians, my consent to receive, treat and/or operate on these cat(s).

 

·        I understand that while all procedures are to be done to the best abilities of the staff, no assurance or guarantee has been made of the results of any surgery or treatment, and that risks and probabilities of complications exist in any surgical or medical treatment.  I consent to the administration of anesthetics and/or other medications as may be deemed necessary by the veterinarian.

 

 

·        I will not hold KC Rescue or the Border Vet Clinic responsible should my cat contract any disease whatsoever.

 

 

 

 

 

I AM AT LEAST 18 YEARS OF AGE AND AFTER CAREFULLY READING THE ABOVE, I HAVE SIGNED IN AGREEMENT.

 

 

Registered Cat Owner Name (Print)

 

Registered Cat Owner Signature

 

Date

Your Phone #

 

 

 

Important Information – Please keep this page

 

Below are KC Rescue’s Policies on our Spay and Neuter Program

 

·         The Border Vet Clinic is the only clinic authorized to partake in our Low Income Spay and Neuter Program. The clinic will complete all surgeries at a set location. All cats will receive a mandatory tattoo upon time of sterilization.

 

·          Appointments will be made through KC Rescue and will be booked on a “priority list” (E.g. pregnant cats would be considered as a high priority).

 

 

·         As the registered owner you must pay the agreed upon fee, in cash, at the time you deliver the cat(s) for the surgery appointment. 

 

·         Cats must appear in good health at the time of surgery.

 

Please complete all three (3) pages and mail to

KC RESCUE  Box 613  Unity,  Sask.  S0K 4L0