Application

HART Spay/Neuter Program Application Form
The Spay/Neuter Program covers only the cost of the surgery. Cat spay/neuters will cost you only $55, and dog spay/neuters will cost you only $65. Please complete the following information. If you have any questions, you send them via regular mail or via email to HARTNMHP@bellsouth.net.

Name________________________________________________________________________

Address______________________________________________________________________

City /State/Zip_________________________________________________________________

Day Phone ________________________ Evening Phone______________________________

Name of Animal (only one per application)________________________

Cat/Dog, Male/Female____________________________________

Please check all categories that apply to your family:

__Low Family Income proof required __Receiving Federal or State Financial Assistance,

__Senior Citizen / Disabled __Rescued, Feral or Stray Animal (explain below)

__Adopted from a recognized shelter or rescue organization
(Name of shelter/rescue org: ________________________________)

__Other Special Circumstances (please describe below)

________________________________________________________________________________________________________________________________

NOTE: Pedigreed animals purchased from breeders or pet stores generally do not qualify!
I certify the above statements are true to the best of my knowledge.

Signature:

_______________________________________________Date____________
Mail the completed form(s) for each animal with a check or money order (no cash,please) for:

$65.00 for dog spay/neuter (each dog)

$55.00 for cat spay/neuter (each cat)
and include a Self Addressed Stamped Envelope to:

HART Spay/Neuter Program
3102 Martin Rd.
Red Bank, TN 37415

HART's Spay/Neuter Program
Program Information
Client Instructions

HART's Spay/Neuter Program is designed to assist qualifying individuals with the cost of spaying or neutering animals in their immediate care. The program is sponsored with the help of concerned Veterinarians in our community.

Prospective clients must meet at least one of the following eligibility requirements to qualify:
Low Family Income
Receiving Federal or State Financial Assistance
Rescued Animal
Adopted from a recognized shelter or rescue organization
Senior Citizen
Disabled
Other Special Circumstances as approved by the HART's Board of Directors

The cost of the program is $65 (dogs) / $55 (cats) which is due with your application. See Client Instructions below for the HART Spay/Neuter Program.

Print the application form found on our web page: www.help.hart.net or obtain an application at the Humane Education Society or Pet Placement Center.

Fill out the requested information.

Mail the completed form with a check or money order (no cash, please) for $65 (per dog) or $55 (per cat) for the Spay/Neuter Program along with a Self Addressed Stamped Envelope to:

HART Spay/Neuter Program
3102 Martin Rd.
Red Bank, TN 37415

If approved, you will receive a Certificate by mail along with a list of participating Veterinarians. Make an appointment with the participating Veterinarian of your choice. Follow the Veterinarian's recommendations in regard to vaccinations, the appropriate age to perform the surgery, etc. Take the Certificate and the animal to the Veterinarian to perform the surgery. The $65/$55 fee for the Spay/Neuter Program covers only the cost of surgery and does not cover any other recommended procedures, vaccinations, etc. If you are not approved, your check or money order will be returned to you.

NOTICE (Required by the State):
HART is a recipient of taxpayer funding. If you observe a Director or Volunteer engaging in any activity which you consider to be illegal, improper, or wasteful, Please call the State Comproller's Toll Free Hotline: 1-800-232-5454

Please support our participating veterinarians! *
Humane Animal Rescue Team