WEBSITE: www.nwass.ca

SPAY AND NEUTER ASSISTANCE PROGRAM

Northwest Animal Shelter Society (NWASS) works with local vets who have generously reduced their regular prices for those who cannot otherwise afford to have their pets or strays spayed or neutered.  The SNAP program has been created for people with genuine financial need.  The vets rely on us to pre-approve applicants. Their good faith in us as well as applicants’ honesty is vital to this program. If you qualify, NWASS will pay the veterinarian some of the cost on behalf of the pet owner. 
Applications must be approved by 2 NWASS board members so the applications need to be dropped off in advance of the animal coming for altering. Applications must be brought to the Vets prior to booking appt or bringing in animal. Please allow at least 7 days for application to be processed and assessed. 

You must supply all the information requested on this form.

Drop off your completed application to Babine Pet Hospital or BV Vet Clinic.

How did you hear about the Northwest Animal Shelter Society? Circle one

Newspaper Radio Poster Flyer Fundraising Event

Word-of-mouth Other: ____________________________________

Part 1 – The Animal: Please fill out for Dog or Cat

I received this animal from: (please check one):

 _____ Pet shop  _____ Shelter   _____ Relative   _____ Breeder   ____ Friend    ____ Found

Other (please explain):  _____________________________________________________

Did you pay for this animal? YES | NO

If yes, how much? ______________

Condition of Animal: (please check all that apply):

_____ Appears Healthy   _____Runny Eyes/Nose     _____ In Heat     _____ Pregnant    

_____ Fleas/Mites _____Friendly     _____ Bites/Scratches     _____ Feral (wild)

Does the animal have a wound, injury or any other health problems that you know of?

(Please Describe):

_______________________________________________________________________________

______________________________________________________________________________

_____________________________________________________________________________

Part 2 – Personal & Financial Information

Declare ALL income coming into your home

Your Name: ______________________________________________________________________

Phone Number: (day) __________________________ (evening) ___________________________

Address _________________________________ City ___________________

Postal code ____________

Employer/Income Source: ____________________________________________ __________     

Gross (pre-tax) Income __________________________________ (per month or per year)

Spouse/Other Adult in Household:

Name: _____________________________________ Relationship: _________________________

Employer/Income Source: _____________________________________________  

Gross (pre-tax) income _________________________________ (per month or per year)

How many children in your home:  _______   List their ages: __________________________

In the space below, list all other animals in your home, male or female +their ages +

whether or not they are fixed. Example: Bud, male dog, 10 years old, fixed

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

Signature: ________________________________________  Date: _____________________________

› I/We authorize NWASS to collect, use and disclose personal information, as deemed necessary, on the applicant

in connection with the approval of this application and maintenance of the spay/neuter program. 

All personal information collected will be kept confidential.

Drop off your completed application to Babine Pet Hospital or BV Vet Clinic.