VACCINE VOUCHER APPLICATION

1. APPLICANT INFORMATION

2. ANIMAL INFORMATION

If multiple animals, complete 1 application for each animal.

Species(Required)
Gender(Required)
Is your animal up-to-date on Rabies shot?(Required)
Is your animal Spayed or Neutered?(Required)
Is your animal microchipped?(Required)

3. Please attach the following documentation

Low-income verification: 1) Section 8 or other housing subsidy documents, 2) SNAP, 3) WIC, 4) PG&E CARES/FERA, 5) SSDI, 6) SSI 7) Unemployment insurance or other general assistance benefits
Max. file size: 64 MB.
Max. file size: 64 MB.
Max. file size: 64 MB.

Limit of 8 cats or dogs total per person. Vaccination fee is $45 per animal. There is a $25 refundable appointment deposit per animal; this deposit will be refunded in full after appointment is honored. This deposit is forfeited in case of no-show.

I hereby fully and completely release, indemnify, and hold harmless Humane Society of the North Bay, its directors, officers, volunteers, agents, servants, and employees from any claim, cause of action or liability of any sort or nature, whether known or unknown, directly arising out of or in connection with the vet services provided for this animal.

This field is for validation purposes and should be left unchanged.