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Spay and Neuter Appointment Request Form
By filling out this form you are certifying you have read and agree to abide by the spay and neuter program policies:
I certify that I live in Logan County, Kentucky, and own cats and/or dogs.
I certify that I am experiencing financial difficulties paying for my pet to be spayed or neutered.
I understand that this service is funded by donations to Spayed and Aid of Kentucky.
I understand that completing this form does not guarantee my pet will get a spot in the program.
I understand that total spots for the program may be limited since appointments for surgeries are based on donations.
I understand a valid driver's license or state id showing Logan County residence is required.
I understand that at this time spots are limited to 1 animal per family. (This may change in the future.)
I understand that Spayed and Aid of Kentucky is paying for the procedure but is not involved in any medical decision making.
I understand that all liability for the medical procedure is held by the veterinarian.
I understand that the medical procedure may be postponed by the veterinarian because of my pet's health, age or any other reason.
I agree to hold Spayed and Aid of Kentucky harmless in all instances.
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* Indicates required question
Email
*
Your email
Pet's Name
*
Your answer
Type of Pet
*
Cat
Dog
Age of Pet
*
Your answer
Is this pet pregnant?
*
Yes
No
Maybe
Owner's Name
Your answer
Owner's Phone Number
Your answer
Owner's Email Address
Your answer
Physical Address (including city/state/zip)
*
Your answer
Is the owner a veteran?
*
Yes
No
Is the owner aged 60 or over?
*
Yes
No
Is the owner disabled or drawing disability?
*
Yes
No
Have you already taken advantage of this program with one of your pets?
*
Yes
No
Are you filling out this form online?
*
Yes
No
Who is your current vet? (If none, type "None")
*
Your answer
Other info we need to know?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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