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[contact-form-7 id="No contact forms found" title="Contact"]
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" indicates required fields
Standard Owned Pet S/N Assistance Program Application
Please fill out one form per animal.
My pet is a...
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Cat living in Chaffee County
Pit Bull Breed or Predominately Pit Bull Mix living in Chaffee County
Pet Owner's Name
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First
Last
Physical Address.
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Street Address
Address Line 2
City
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ZIP Code
Phone Number
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Email Address
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Pet's Name:
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Sex of Pet:
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Male
Female
Approximate weight:
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Approximate age:
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Primary Color:
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Secondary Color and/or Color Pattern:
Primary Breed:
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Secondary Breed:
Hair Type
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Short Hair
Medium Hair
Long Hair
Please let us know the amount you are able to afford as a co-payment at the time of your appointment.
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Due to limited grant funding, a minimum spay/neuter co-pay of $50 per cat and $100 per dog is required for our Standard Owned Pet S/N Assistance Program, with payment due at time of surgery.
Please enter a number greater than or equal to
50
.
Pet Medical History
Has your pet had a heat cycle?
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A heat cycle in pets typically appears as swelling of the vulva, increased licking of the genital area, and bloody vaginal discharge, often accompanied by changes in behavior such as increased affection or restlessness.
Yes
No
Unsure
If "yes", what was the date of your pet's most recent heat cycle?
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Write N/A if unsure.
Does your pet regularly take any medication?
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Yes
No
If "yes", please list the medications and their dose/frequency here.
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Ok to copy instructions from bottle.
Has your pet been diagnosed with, or have you noticed, any abnormality of the following systems?
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Eyes, ears, nose, mouth
Skin, coat
Skeletal (for example: deformity, recent or past injury, bone cancer, etc.)
Respiratory
Cardiovascular
Neurological
Other
None of the above
If you checked any boxes above, please briefly describe here:
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Does your pet require any special handling at the vet?
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For example: Muzzle, additional restraint, etc. If your pet has not visited a vet, please describe your pet's behavior with strangers and/or handling.
Additional Options
Along with the spay or neuter surgery, our program can include an RCP vaccination (cats) or DAPP vaccination (dogs), a rabies vaccination, and a microchip at the time of surgery, at no additional cost. Additional purchase options include a post-surgical cone and/or pre-surgical blood work. All of the following options can be adjusted when you drop your pet off for surgery.
Can we give your pet a free rabies vaccine at the time of surgery?
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Rabies is a deadly disease that can be transmitted to humans and other mammals, making vaccination crucial for public health. Puppies and kittens get a rabies vaccination no earlier than 12 weeks of age. After their first rabies vaccination, all cats and dogs need a booster 1 year later, and then once every 3 years.
Yes
No
Optional: If your pet has previously been vaccinated against rabies, please upload a photo of your pet's rabies certificate here.
Max. file size: 256 MB.
Can we give your pet to receive a free distemper combo vaccine at the time of surgery?
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RCP vaccination for cats, DAPP vaccination for dogs. RCP (cats) protects against feline rhinotracheitis (herpesvirus), calicivirus, and panleukopenia, while DAPP (dogs) protects against distemper, adenovirus (hepatitis), parvovirus, and parainfluenza—all highly contagious and potentially fatal diseases, making these core vaccines essential for preventing serious illness and death. Young cats and dogs can receive a distemper combination vaccination starting no earlier than 6 weeks of age. They should then receive a series of at least three boosters, ending when they are at least 4 months old. After this initial series, all cats and dogs, regardless of when they began vaccination, will require ongoing booster vaccinations every 1-3 years to maintain protection. Healthy cats and dogs over 4 months of age who have not previously been vaccinated should receive an initial dose, followed by boosters every 1-3 years thereafter.
Yes
No
Has your pet previously been vaccinated with a distemper combo vaccine?
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Yes
No
Unsure
Optional: If your pet has previously been vaccinated with a distemper combo vaccine, please upload a photo of your pet's veterinary records here.
Max. file size: 256 MB.
Can we give your pet a free microchip at the time of surgery?
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A microchip is a permanent way to link your contact information with your pet. It contains only a unique identifying number, stores no further information, and is not able to be tracked. Your contact information is stored with the microchip company and you are able to control privacy of this information. If your pet's chip is scanned, the microchip company is contacted by the organization who has scanned it (usually a vet clinic or animal shelter). Your contact preferences are then followed.
Yes
No
Would you like to purchase a $5 post-surgical cone (E-collar) to help prevent your pet from licking or irritating the incision site during recovery?
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The cost for animal cones is $5. This cost is separate from any co-pay amount, with payment due at the time of surgery. This purchase is optional and may be added or declined on the day of the procedure. A post-surgical cone (Elizabethan Collar) is an effective tool in preventing your pet from licking their incision. When a pet is allowed to lick their incision they may cause infection, or they may even re-open the incision, both of which would require immediate veterinary care not covered by this Community Assistance Program. Cones will be fitted by AVHS staff at the time of surgery.
Yes
No
Unsure
Would you like to purchase pre-surgical blood work at the time of your pet’s surgery for $85?
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The cost for pre-surgical bloodwork is $85. This cost is separate from any co-pay amount, with payment due at the time of surgery. This purchase is optional and may be added or declined on the day of the procedure. This screening, performed on the morning of the scheduled surgery, helps assess underlying conditions and overall health prior to anesthesia, for your pet’s safety. Pre-surgical bloodwork is not guaranteed to catch all underlying conditions, but is generally regarded as an effective screening tool. For animals over 8 years of age, it is strongly recommended.
Yes
No
Unsure
Required Documents
Please attach a photo of your pet:
Max. file size: 256 MB.
Please attach a copy of your drivers license or other official document that includes your name and local address:
For proof of residency in Chaffee County.
Max. file size: 256 MB.
Consent Questions
Spay Tattoo Agreement
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The pet owner understands that all female pets will receive a small standard tattoo to visually indicate that the animal has been spayed.
Consent to Share Information
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The pet owner agrees that the information on this form is correct and allows Ark-Valley Humane Society to share the information provided with the supporters of the program (private parties, foundations, governments) for the purpose of documenting this spay/neuter program.
After submitting the application please keep an eye on your email for further instructions. You'll receive a follow up email soon.
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