The “Fix A Kitty” Cat Sterilization Program offers spay or neuter of cats at the SPCA of North Brevard. The cost for each cat is $20.00, payable in advance. Rabies (1 year) and distemper (FVRCP) shots are included at no additional charge for cats who need them. Other services requested, provided, or deemed necessary by the veterinarian may be incurred at the cat guardian’s expense.
Cat Guardian’s Name ______
Phone numbers: (home) ______(work) ______(cell) ______
Address______City ______State _____ Zip Code______
Cat’s name ______Age ______Weight ______Sex M F Pregnant? ______
Date of last litter ______Last rabies shot ______Last FVRCP shot ______
Check here ______if you have additional cats to sterilize, and list them on the other side of this page.
Name of Veterinarian ______Office phone number ______
How many other pets do you have? Cats ______Dogs ______Are they all sterilized? ______
** What is the total yearly income of your household? $______
** How many adults in your family? ______How many children? ______
** Please check any public assistance that you receive or any that describe your situation:
_____ My only income is social security
_____ I am disabled on SSDI
_____ I receive SSI
_____ I am on Medicaid
_____ I receive food stamps
_____ I am unemployed
_____ I receive Federal Public Housing Assistance (FPHA)
_____ I receive Low Income Home Energy Assistance (LIHEAP)
_____ Other (please describe) ______
Please contact the SPCA (321-269-0536) for an appointment. Bring this completed application to the SPCA at or before the time of your appointment. You will need to transport your cat to the SPCA in the morning and pick him/her when s/he is released.
All medical procedures carry some risk, although it is very low for sterilization surgery, and rabies or distemper immunizations. Animal Guardians and the SPCA cannot be held liable for any unexpected outcomes.
I am requesting sterilization of my cat(s) described above. This information is true and correct to the best of my knowledge.
Cat Guardian’s Signature ______Date ______
Eligibility verified by (signature of representative of SPCA) ______
Date of appointment ______
1 This program is for low income cat guardians.
2 Please call the SPCA (321-269-0536) for an appointment. You may also apply in person at the SPCA.
3 Please complete this application and submit it to the SPCA at or before the time of your appointment. All questions must be answered. Please be sure to sign your application.
4 Payment of $20.00 is required when you make your appointment.
5 You will need to transport your cat to the clinic and pick him/her up when s/he is released.
6 The SPCA will provide pre-operative instructions.
You agree to try and provide a life-long, safe, loving home for your pets. This includes exploring any and all remedies for problems, and searching out every safe alternative before ever relinquishing your pets to a shelter. You agree to never abandon your pets.
For more information please contact:
SPCA of North Brevard
455 Cheney Highway (SR 50 at Sisson Rd.)
Titusville, FL. 32780-7265
321-269-0536
www.spcanorthbrevard.com
OR
Animal Guardians of Brevard
www.animalguardiansofbrevard.org
Rev. 5/12