Snoop Assistance Chenango SPCA Assistance Program ApplicationSNOOP Application InformationPlease Check One:*Public AssistanceLow IncomeP#Name*Other Household Members (Over the age of 18)AddressTown/CityStateZipPrimary PhoneCountryEmail Adresss OccupationEmployer You must provide proof of Chenango Country Residency and proof of assistance . This agreement is not an automatic approval for funds. I am applying for SNOOP for the following pet(s) Pet1NameSpecies/ BreedAgeColorSexMaleFemaleWhere did pet come fromDog Neuter ($80) Dog Spay ($100) Cat Neuter ($40) Cat Spay ($70)Pet2NameSpecies/ BreedAgeColorSexMaleFemaleWhere did pet come fromDog Neuter ($80) Dog Spay ($100) Cat Neuter ($40) Cat Spay ($70)Please read and check the follow items. By doing so, I acknowledge that I am applying for assistance for my pet(s) through one of the Chenango SPCA's Assistance Programs and agree to the following:SNOOPSNOOP Agreement List I give permission to the veterinarian office to discuss the status of my pet's health with the Chenango SPCA I am responsible for providing any/all treatment and will follow the directions given to me by my veterinarian. I am also responsible for any/all payments beyond coverage of the SNOOP Program. I understand that any funds allocated by the Chenango SPCA will be given directly to my veterinarian upon completion of an alter surgery. I am aware that only TWO animals in my household may receive SNOOP funds per the calendar year and that I must re-apply every year for further assistance. SNOOP Agreement List Once I am notified of program approval, I agree to schedule spay/neuter appointment(s) within 30 days of approval. I agree to notify the CSPCA of the surgery appointment in advance, and it is my reponsiblity to make sure that the veterinarian clinic participates in the SNOOP Program. If I acquire additional pets, my application will become void and I will not be eligible for further assistance by the CSPCA. If the surgery is not completed within 30 days after approval date and extension may be granted at the CSPCA's discretion. My application will become VOID if the animals are not spayed/ neutered within 90 days after the application has been approved. Applicant SignatureAccepted file types: jpg, png.Date Date Format: MM slash DD slash YYYY CSPCA Staff SignatureAccepted file types: jpg, png.Date Date Format: MM slash DD slash YYYY Pets at Home Please fill out for every remaining pet in the home How Many DogHow Many CatPet1NameSpecies/ BreedAgeColorSexMaleFemaleWhere did pet come fromIs pet already Spayed/Neutered?Pet2NameSpecies/ BreedAgeColorSexMaleFemaleWhere did pet come fromIs pet already Spayed/Neutered?Pet3NameSpecies/ BreedAgeColorSexMaleFemaleWhere did pet come fromIs pet already Spayed/Neutered?Pet4NameSpecies/ BreedAgeColorSexMaleFemaleWhere did pet come fromIs pet already Spayed/Neutered?Pet5NameSpecies/ BreedAgeColorSexMaleFemaleWhere did pet come fromIs pet already Spayed/Neutered?Pet6NameSpecies/ BreedAgeColorSexMaleFemaleWhere did pet come fromIs pet already Spayed/Neutered? Download Form Our Proud Sponsors and Partners
