NEW - Provincial Animal Shelter & Veterinary Clinic Public Spay & Neuter Application Step 1 of 3 33% Please upload Proof of Income*Proof of income is required to qualify for the program. This can be a statement of assistance if you are on social assistance, or a Notice of Assessment from Revenue Canada. Please attach here, if you do not have a copy to attached you can not complete the applicaton online, you will need to do so IN PERSON at the shelter at 5 Scarfe Crt, or email it to firstname.lastname@example.org. You will be contacted only when you have provided this documentation. Only ONE file can be uploaded here (maximum 100kb), email any additional information to email@example.comCONTACT INFORMATIONDate* Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code I am located in the following municipality:*Halifax/Dartmouth and surrounding regionHants CountyQueens CountyLunenburg CountyOtherContact Number*Alternate Contact NumberEmail Enter Email Confirm Email How did you hear about our Spay & Neuter Services?Have you applied to us before?*NoYes ANIMAL INFORMATIONAnimal Name*First Animal Information*CatDogWeight Range - FOR DOGS ONLY0- 45lbs50 - 100lbs100 + lbsPlease provide us with the approximate weight range of your dog, so we can ensure we assign an appropriate kennel size for your pets visit. Gender*MaleFemaleI don't knowAge?*in yearsColour/Description?Animal NameSecond Animal InformationCatDogGenderMaleFemaleI don't knowAge?please enter your pets age (in years)Colour/Description?Is your animal(s) on any medications?YesNoIf yes, please list medications and reasons for taking them...Is your pet showing any of these symptoms: vomitting, rash or diarrhea?*YesNoHow did you get your pet?* Stray Breeder Kijiji Rescue Group Other Do you currently have a Veternarian?*YesNoIf yes, what is the name of your Vet Clinic?Is this a TNR? (if yes, please note there are additional fees and outpatient instructions for TNR services)*YesNoSee for more information on what TNR means visit: spcans.ca/spca-vet-services/trap-neuter-return/ FINANCIAL INFORMATIONAre you on Public Assistance?*YesNoDo you receive Disability or Unemployment?*YesNoHow many adults live in this household?*18 years and olderPlease list the TOTAL annual income of your household ($)*Total combined income in $$How many children live in this household? (under 18 years old)*CONSENT (click on text below to agree to the statement)* Yes - by submitting this form I hereby cerifty that the information i have provided is truthful and correct to the best of my knowledge. I hereby agree to waive any and all claims for damages against the Nova Scotia SPCA, and any officers, volunteers, or agents of the program in the event of death or injury to the animal during surgery. I also consent to the SPCA contacting me regarding this application.