Spay - Neuter Application Form
PUTNAM COUNTY OHIO RESIDENTS ONLY!!

To qualify for this voucher, applicants must be a resident of Putnam County, OHIO, and one of the following:
-A Veteran
-Over the age of 65
-Receive Social Security/Disability
-Receive SNAP Benefits 

If applying for a dog, the animal MUST have a current Putnam County Dog License.
 
* Answers to ALL questions are required.

*Errors & omissions on the form will delay processing.

*Applications will be reviewed ONCE a month at our meetings held at the Putnam County Dog Shelter on the 2nd Tuesday of each month. You will be notified via email or phone  within approximately 1- 2 weeks after the meeting if you qualify for a voucher.*
We will pay up to $150 for a cat spay/neuter, and up to $200 for a dog spay or neuter.
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Untitled Title
Name of pet owner *
Phone # *
Email address *
Today's Date *
MM
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DD
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Street Address *
Apartment Number or PO Box #
City, State, Zip code *
Pet needing spayed or neutered *
If your pet is a dog, does it have a Putnam County Dog License? *
Pet's Gender? *
Pet's Name *
Pet's Age *
Pet's Approximate Weight *
 If the pet is a dog, what is its breed (if known)? *
Where did you acquire your pet? *
Does your pet sleep indoors or outdoors? *
Has your pet given birth to any litters or fathered any litters? *
Are there other unaltered pets in the household? *
Tell us about your financial situation, please. *
Please check ALL that apply *
Required
Which Veterinarian below would you use if awarded a voucher *
If you chose “other” as an option in the previous question, please list the name and phone number of the veterinary clinic you would like to use. *
Applications will be reviewed ONCE a month at our meetings held at the Putnam County Dog Shelter on the 2nd Tuesday of each month. Failure to thoroughly answer all questions will result in delays processing your application. Putnam Pet Pals is run by a group of volunteers. They reserve the right to deny anyone a Spay & Neuter Voucher. * Disagreeing with any of these statement means automatic disqualification. * *
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