Thank you for your interest in the Delaware $20 Spay & Neuter Program, from the Delaware Division of Public Health’s Office of Animal Welfare and its partners. Please complete all lines of the application. It may take 15 business days to process your application. If your pet needs immediate medical attention, call your veterinarian, or take them to the nearest veterinary emergency care facility.

TO COMPLETE APPLICATION:
1. Read Disclaimer, Accept Terms of Eligibility Agreement and click “Agree”.
2. Fill out the Spay & Neuter Income Eligibility Application below. Be sure to fill all form fields.
3. Upload a copy or photo of a valid Delaware State Photo I.D. as proof of identity.
Those on Federal assistance must upload a copy of their latest Annual Proof of Benefits Letter.
4. Type your full name in the box below to act as your Electronic Signature. Once completed click “Submit”.

A box will appear giving you confirmation of a successful submission. You can then leave this page

INCOME ELIGIBLE APPLICATION DISCLAIMER (YOU MUST CLICK AGREE TO CONTINUE)

I hereby consent to the surgical spaying or neutering of my cat(s) and/or dog(s) by a Delaware licensed veterinarian. If my animal is not currently immunized against rabies, I hereby consent to the administration of a rabies immunization to my animal at the time of the surgical procedure.

I understand that some veterinary practices may require additional care, tests, or vaccines, and I am responsible to pay for these extra services. I understand it is my responsibility to ask whether the veterinarian requires other care, tests, or vaccines when I call to schedule the spay or neuter surgery. I understand that if I reject these tests, the veterinarian may elect not to perform the spay or neuter procedure. I understand I need to follow pre-surgical and post-surgical care instructions given to me by the surgery provider. I understand there are inherent risks involved in medical procedures and surgery.

I agree to update the Spay & Neuter Program coordinator if my contact information changes.

I agree to notify the Spay & Neuter Program coordinator if I decide not to follow through with the spay/neuter surgery.

I authorize release of the information above for the purpose of determining my eligibility for the Spay & Neuter Program.

I understand submitting an incomplete application may delay the processing of that application.

I affirm that I am the owner/keeper of the animal(s) listed on this application.

I understand that under Delaware code, Title 16, Chapter 30F, Subchapter II: Any person who knowingly falsifies proof of eligibility for, or participation in, any program established under this chapter, or who knowingly furnishes any licensed veterinarian with inaccurate information concerning ownership of a pet submitted for sterilization, or who falsifies an animal sterilization certificate shall be guilty of an unclassified misdemeanor and shall be subject to a minimum mandatory fine, which shall not be subject to suspension, of $250.

Agree

Application

DELAWARE SPAY & NEUTER PROGRAM INCOME ELIGIBLE APPLICATION

A new application is required each fiscal year and/or for additional animals not listed below. Authorized under TITLE 16, CHAPTER 30F, SUBCHAPTER II: Any falsification of information is subject to an administrative fine of up to $250.

ANIMAL OWNER ELIGIBILITY

You must receive benefits from at least one of the following programs to qualify for the Spay & Neuter Program.

Please check which type of assistance you receive.

*Applicants who receive Federal assistance must attach a scan or photo of your annual Proof of Benefits letter. If you do not have a copy of your Proof of Benefits letter, you may request one through the Social Security Administration or Veterans Administration. Standard retirement or widow benefits do not qualify.

ANIMAL INFORMATION

You may apply to have up to three animals (cats or dogs) spayed or neutered per State fiscal year (July 1 – June 30).

Animal 1
Animal 2
Animal 3

Upload Your Attachments

Drop a file here or click to upload Choose File
Maximum upload size: 8.39MB
Valid Delaware State Photo I.D. as proof of identity.
Drop a file here or click to upload Choose File
Maximum upload size: 8.39MB
Latest Annual Proof of Benefits Letter.
Sending
http://showroom-kiev.com.ua/
http://shtory.ua/
http://www.rbt.com.ua
http://profshina.kiev.ua/