Spay/Neuter Clinic Information Spay/Neuter Clinic Client Information Thank you for your interest in the Humane Society of Schuyler County's spay/neuter clinics for income-eligible residents of Schuyler County and surrounding area. Please provide us with the following information and we will be in touch with you about scheduling and clinic procedures. Thank you for spaying or neutering your pet! Information About YouPlease provide us with the requested contact information and best way to stay in touch with youName* First Last Address* Street Address Address Line 2 City State StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code County*In which county do you live?Phone*EmailPlease provide us with an email address if you have one and check it regularly. If you don't use email, we will contact you by telephone. How would you like us to contact you?PhoneEmailPostal ServiceEligibilityThese questions will help us verify your income eligibility for our spay/neuter clinic. Even if you do not receive benefits, you may still be eligible for this program.Household*How many persons live in your household?Assistance*Does anyone in your household receive any financial assistance? You may be eligible for additional assistance if you send proof of benefits to lday@schuylerhumane.org, text it to (607) 301-0130 or bring it with you at drop off SNAP HEAP WIC SSI/SSD Unemployment Workers compensation Other None Household IncomeWhat is the yearly income of your household? You do not have to answer this question, but it may help us determine eligibility if you are not receiving financial assistance.AlternativesWould you have been able to spay/neuter your pet without this program?YesNoInformation About Your PetPlease provide us with as much information as you can about your pet. This will help us with scheduling and ensuring that we have the right supplies for surgery.Your Pet's NameSpecies*DogOwned CatFeral CatAge*Please enter your best estimate of your pet's ageSex*MaleFemaleUnknownWeight*Please enter your best estimate of your pet's weightColorDog or cat's colorBreedBreed, especially for dogs. You don't have to be precise - a generic breed such as retriever, hound, beagle, shepherd, or pit bull is fine.Distemper (DHLPP) vaccinationPlease choose the status of your pet's distemper vaccination. If you have a distemper vaccination certificate, please bring it with you. Never vaccinatedPrevious vaccinationUp To Date on vaccinationRabies vaccination status*Please choose the status of your pet's rabies vaccination. If your pet has had a recent rabies vaccination, please send a copy to lday@schuylerhumane.org or text a photo of the certificate to 607-301-0130, or bring it with you at drop off.Never VaccinatedPrevious vaccinationUp To Date on vaccinationsAdditional informationWhat else should we know about your pet? Is there an existing medical condition? Are we likely to have any problems handling your pet?
