APPLICATION FOR SPAY/NEUTER VOUCHER

Mission Statement:

The Humane Society of Livingston County through education and caring Will work toward elimination of abuse and overpopulation of animals and Aid in the prevention of their suffering within our community.

For grant purposes, check your household income level below:
 ___ $15,000 or less    ___$15,000 - $20,000    ___$20,000 - $30,000    ___$30,000 - $40,000    ___ over $40,000

PLEASE READ THE IMPORTANT INFORMATION BELOW:

·       There is a limit of two (2) vouchers per person per year and membership to HSLC is required.

·       The HSLC voucher provided to you covers a portion Spay/Neuter surgery only. 
The owner is responsible for any additional expenses associated with the office visit and surgery.

·       Each voucher has a 60-day expiration date from date of issue.

·       You must use a Livingston County Veterinarian.  For participating Livingston County Veterinarians, reimbursement
from the HSLC will go directly to them and the amount allotted will be deducted from your bill. For those Livingston
County Veterinarians that do not acknowledge our vouchers at the time of your payment - you must send a copy of the
itemized bill back with the voucher sent to you and HSLC will send you your reimbursement.

·       Privacy Policy: Information you give HSLC is confidential and won’t be shared with other individuals or organizations.

List name(s), type, sex, age, and weight of pet(s) you wish to have sterilized:

Pet’s name 1______________________Cat/Dog________Male/Female__________Age________Wt_________

                 2______________________Cat/Dog________Male/Female__________Age________Wt_________

Please fill in the personal information below:

Owner Name:_______________________________________Street:_____________________________________

Town:__________________________________Zip:__________Phone #:_______________HSLC member?____

Please Sign and Date:___________________________________Date:__________Email:_______________

Send your completed application to:      HSLC – Spay/Neuter Program
                                                                            PO Box 233
                                                                            Avon, NY 14414

 You will receive your voucher within one (1) week after HSLC reviews the application.

*Please do not make an appointment for surgery until you receive the voucher.

*The voucher must be given to the veterinarian at the time of surgery if they are a participating vet.

*Questions will be answered by calling 585-234-2828.  Leave a detailed message and your call will be returned.

Back to Spay/Neuter