Pet Care Assistance Application

To apply for Pet Care Assistance, please complete and submit the form below. As we review your eligibility, we may ask for the following information:

A signed application
Confirmation of Windham County residency (copy of driver’s license, passport, item of mail, etc.)
Proof of low income (Social Security / Disability benefits form, pay stub)
Spay | Neuter appointments for any unaltered pets in home

Information about you

Name

First Name

Last Name

Your date of birth

YYYY

Home phone

(###)

###

####

Cell phone

(###)

###

####

Work phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Monthly combined family income before taxes

Reason(s) you are applying for pet care assistance

Terms

With my signature, I certify that the information I have given is true. I understand pet care assistance is being provided to my pets, based on the information above. I understand in order to receive pet care assistance the following conditions must be met: - I am a resident of Windham County, Vermont - I will work with WCHS to have all my pets spayed or neutered - I will not acquire any more pets while I am receiving pet care assistance - I will inform WCHS if my financial status changes such that I no longer require assistance Along with this application, I will supply WCHS the following (please note, if these items are not included, you will not qualify for this program): - Signed copy of Pet Care Assistance Terms - Proof of Windham County residency (copy of driver’s license, passport, item of mail, etc.) - Proof of low income (Social Security / Disability benefits form, pay stub) - Completed spay/neuter application for any unaltered pets in home

I agree to the program's terms as enumerated above.

Yes

Now

Windham County Humane Society's Pet Care Assistance Program

Read More about our Program