Application For General Spay/Neuter Clinics

CLINIC REQUESTED:                                 Please Choose Clinic PAL Mobile Clinic Male Cat Neuter

DATE OF REQUESTED CLINIC:                 (see clinic description for dates)

LOCATION OF REQUESTED CLINIC:      (see clinic description)

Name:   

Address:

Day Phone:              

Evening Phone:       

Cell Phone:               

Email Address:        

PET #1

Name:       Dog          Cat              Age:

Breed:   Male  Female       Weight:

PET #2

Name:     Dog          Cat                Age:

Breed:    Male  Female        Weight: 

THESE CLINICS ARE OPEN TO ALL HOUSEHOLDS REGARDLESS of INCOME

By submitting this application, I agree to accept a complimentary "Participating Membership" in the Grainger County Humane Society. Participating Members may receive newsletters and information about upcoming events, meetings, and volunteer opportunities; but do not receive voting privileges.

Accept Participating Membership

Please keep my name and pets on file for future spay/neuter clinics.

Number of other animals in my care that need spaying or neutering:  Dogs     Cats

You will be notified one week prior to clinic by phone or mail.