SANDS Memorial Foundation Application

I request the Foundation to provide financial assistance for surgically sterilizing my dog/cat. I agree to abide by the requirements for this assistance and any requirements made by the veterinarian who performs the surgery.
I waive any and all claims for damages against the Foundation, the veterinarian performing the surgery and all officers and employees in the event of injury or death of my animal.
I hereby declare under penalty of perjury that I am the owner of (or I am authorized to present for this operation) this animal. I swear all the above information is true to the best of my knowledge and that I cannot afford to pay the usual veterinary fees without assistance.

This portion to be filled out by the veterinarian and returned by veterinarian to the Sands Foundation for payment of assistance amount after completion of surgery.

Thank you for getting your dog or cat spayed or neutered!
You are being a responsible pet owner and that helps you, the animals, and the community in many ways.
This program is open to anyone who cannot afford to have her/his cat or dog spayed or neutered and who meets the Foundation's qualifications for assistance. The Spay/Neuter Program will provide a portion of the cost of the surgery. The remaining amount will be paid to the veterinarian by the applicant.
Applications are available from your veterinarian's office. The application must be filled out completely and a brief interview may be conducted. You will be notified quickly of the Foundation's decision. There may be some restrictions or waiting periods required by the veterinarian, such as if the animal is in heat or has been nursing a litter, so be sure to check with the veterinarian about this.
The Sands Foundation Spay/Neuter Program will pay the following amounts for sterilization:
Male dogs $71.00 Female dogs $84.00 Male cats $43.00 Female cats $64.00
THE PET OWNER MUST PAY ALL REMAINING VETERINARY CHARGES
TO APPLY: Prior to surgery, fill out and sign the Application, Consent and Waiver Form. Follow your veterinarians instructions for mailing the application to the Sands Memorial Foundation. (All information will be kept confidential). INCOMPLETE APPLICATIONS CANNOT BE APPROVED. Approval is sent to the veterinarian following review by the Sands Foundation. After the surgery, payment of the approved amount is sent to the veterinarian.
If you have questions that cannot be answered by your veterinarian, please feel free to contact our office. We can assist with questions about filling out the forms, as well. Thank you, again, for being a responsible pet owner.
MORE NEUTERED PETS MEANS FEWER HOMELESS ANIMALS! SANDS MEMORIAL FOUNDATION, INC.
P.O. Box 1450
Havre MT 59501
(406) 265-4271