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Public Spay & Neuter Application

  1. Public Spay and Neuter Application
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  2. Animal's Sex*
  3. Animal Type*
  4. Has the animal bitten anyone in the past 10 days?*
  5. If yes, did it break skin?*
  6. If the animal is a cat, is it feral?*
    If yes, rabies vaccination and an ear tip are required.
  7. If your cat spends time outside we encourage ear tipping, that indicates it has been spayed/neutered and vaccinated. Would you like us to ear tip the cat?
  8. Vaccination Status: We recommend vaccination before surgery for your pets protection (Please provide proof of current vaccination history, although vaccination is not required for surgery.)
  9. Medical History: If your pet is currently being treated for seizures, heartworm disease, cardiac issues, or any other preexisting condition, please note that because of the risk involved, these conditions automatically disqualify them for sterilization at our shelter.
  10. My pet DOES or DOES NOT have any pre-existing conditions.*
  11. If you would like us to vaccinate your pet please mark which vaccines you would like and prices are listed:*
  12. I authorize that this information is correct and current to the best of my knowledge. The Farmington Regional Animal Shelter will not be held liable for any circumstances including the death of my pet if any of this information has been falsified. If you miss your sterilization appointment without give 48 hours of advanced notice you will forfeit your payment.
  13. Income & Residency Verification:
    Household incomes over $60,000/yr do not qualify for our program. The program is income based and uses household income to determine eligibility and price. You must upload Proof of Income in the form of a filed tax return, Medicaid/Medicare card, or reduced school lunch program for proof of income. You must also upload Proof of Residency such as a utility bill.
  14. Leave This Blank:

  15. This field is not part of the form submission.