VOUCHERS ARE MAILED AT THE BEGINNING OF EACH MONTH. AT TIMES, THERE MAY BE A WAITING LIST FOR SPAY/NEUTER VOUCHERS. WE ENCOURAGE YOU TO COMPLETE THE FORM TO GET ON THE LIST. PLEASE PROVIDE A WORKING PHONE NUMBER AND EMAIL ADDRESS IN CASE WE NEED TO CONTACT YOU FOR ADDITIONAL INFORMATION.

THIS PROGRAM IS FOR PET GUARDIANS IN MARLBORO COUNTY, SOUTH CAROLINA. THE SPAY OR NEUTER PROCEDURE WILL BE PERFORMED AT BENNETTSVILLE ANIMAL HOSPTIAL.

Are you a resident of Marlboro County, South Carolina?
 Yes No

How did you hear about the Spay/Neuter Program?

Name

Phone Number

Your voucher will be mailed to you. Please provide a valid mailing address.

Email Address

Below are questions regarding your pet. Please provide as much information as possible. If you’re applying for multiple pets, please provide information for all.

What type of pet are you applying for a voucher for?
 Dog Cat

Is this pet currently and will remain a permanent part of your family?
 Yes No

Name of pet:

Gender
 Male Female

Age

Weight

Breed

Is your pet an indoor or outdoor pet?
 Indoor Outdoor

If female, has your pet had a litter in the past?
 Yes No

If yes, how many?

Where did you get your pet?
 Adopted Found/Stray Gift Bought Other

If other, please explain.

Tell us a little about your pet. What makes them special to your family? What is their personality like?

Please attach a picture of your pet.

If you receive a voucher, may we use pictures/information about your pet(s) on our social media outlets, newsletters, and other marketing material? This information is helpful in raising funds to continue the program.
 Yes No

I hereby certify that the foregoing information is true and correct and that I have not omitted anything which would make my application false or misleading.

I understand that my voucher will cover the spay/neuter surgery, pain medication, and rabies vaccine. Any additional services/charges must be paid by myself, the pet guardian.

By using the voucher, I understand that my pet may have a pre-existing condition, which may not be apparent at the time of surgery and could increase the anesthetic and post-surgical recovery risk. I agree that Angel’s Hope and/or the veterinarian providing services will not be held liable or responsible for any possible health complications arising from the services provided for by this voucher.

I agree to participate in this program, assume all risks, and voluntarily agree to this waiver of liability.

Signature

Date