Application for OHS Feral Spay-Neuter Assistance Voucher - FOR RESIDENTS OF FREMONT, NEWARK, OR UNION CITY ONLY 
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THIS APPLICATION IS NOT A SPAY-NEUTER VOUCHER:  
DETERMINE WHICH OF OUR PARTNER VETERINARY CLINICS YOU WILL USE BEFORE APPLYING. 
PLEASE SEE INSTRUCTIONS ON THE WEBPAGE AT https://ohlonehumanesociety.org/spay-neuter-assistance/ BEFORE COMPLETING THIS FORM.     THANK YOU!
Ohlone Humane Society, Inc.
DO NOT trap a feral cat until AFTER you've made the surgery appointment! 

TRAP THE DAY BEFORE THE APPOINTMENT!

This voucher is NOT to be used for tame cats - you will be responsible for the entire cost of surgery or turned away if not a feral cat.
Are you applying for vouchers representing an organization or are you an independent trapper or homeowner? (please check which describes the reason for the application) 
If applying as an organization or rescue, please identify the name of your group and zip code.
Applicant's First and Last Name   *
Applicant's complete street address (PROOF OF ADDRESS REQUIRED) *
Applicant's City (FREMONT, NEWARK OR UNION CITY ONLY - SELECT ONE) *
Applicant's zip code *
Phone   *
Email for Vouchers *
Address/location of cat (FREMONT, NEWARK, OR UNION CITY ONLY) *
Zip code of cat location *
Number of vouchers needed (Limit: 4 vouchers per application) *
I release Ohlone Humane Society (OHS) from all responsibility arising from the surgery and any/all resultant complications that arise from handling and dealing with feral cats. I take full responsibility for any cats that I trap. *
I understand that a veterinarian of OHS's choosing will perform the surgery and that any spay or neuter performed by a veterinarian other than the one listed on my voucher will be completely at my expense. I must wait to have a voucher in hand before going to the surgery appointment. *
I understand the voucher program only covers the cost of spay-neuter surgery and that I am responsible for the voucher copay and any/all additional expenses, including surcharges for injured, pregnant or in-heat cats. *
I understand what a true feral is. A feral is a cat that cannot be handled in any way -- not to be confused with a stray cat that is friendly. FERAL vouchers will NOT be accepted for tame cats! *
I understand that all feral cats using OHS vouchers must have their ear tipped. *
If the veterinarian feels the feral cat is in poor health and should be euthanized, this voucher will be used for euthanasia and disposal of the remains. *
I certify that I am at least 18 years of age and can provide proof that I am a resident of Fremont, Union City or Newark. *
I have read and understand and accept all terms set forth in this application and verify that all of the information is true. By submitting this application, I am electronically signing and agreeing to the terms of the application .By submitting this form, I consent to the use of my contact information by and to receive emails from representatives of Ohlone Humane Society. I understand I can revoke my consent to receive emails at any time by emailing privacy@ohlonehumanesociety.org.

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Name of OHS Representative Helping Me (if no one assisted you, please enter none)  *
Date of First Scheduled Appointment *
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OHS vouchers are accepted at the listed clinics at this time. For Paws Clinic requires CAT BE IN TRANSFER CAGE.   (select one only) *
Untitled Title
THANK YOU FOR YOUR EFFORTS WITH OUR COMMUNITY CATS.
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