Bama Bully Rescue Spay/Neuter Fund Application

Please note - this application is ONLY for assistance with spay or neuter, if you are looking for additional medical assistance please use the appropriate form.

Thank you for making the choice to alter your dog. There are many resources available for owners/caretakers to receive low-cost or free spay/neuter. Since BBR has limited funds we ask you to check out the following links before applying for assistance to determine if there are low-cost programs in your area.

Friends of Cats & Dogs http://www.fcdf.org/spayneuter-program/
Alabama Animal Adoption Society http://www.animaladoption.org/services/certificates.cfm
PBRC's spay/neuter page - https://www.pbrc.net/spayneuterfund.html#/
Friends of Animals - https://friendsofanimals.org/get-a-certificate/
Spay USA - https://www.animalleague.org/get-involved/spay-usa/
Spay Alabama (by county) - https://spayal.org/find-affordable-spay-neuter/
Alabama Animal Alliance - https://www.alabamaspayneuter.com/services
SNAP Alabama - https://www.snapalabama.com/
Be sure to check with your local shelters and animal control facilities - many times they may know of additional resources in your area.

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

County *

Phone *

Email Address *

Does your family receive any form of public assistance? Please check all that apply. *

The Dog(s)

Who does the dog belong to? *

If this dog is a stray, how long have you been taking care of the dog? *

If this dog is a stray dog, have you taken it to animal control or a veterinarian to be scanned for a microchip? *

If this dog is a stray dog, have you posted its description and location on lost and found Facebook pages and websites (e.g., https://www.facebook.com/ALTornadoAnimals?fref=ts, and https://www.facebook.com/BBRCrossposts/.)? *

If this dog is a stray, please list the ways you have tried to find its owner (lost and found websites and Facebook pages, flyers, etc.) *

What is the dog's name? *

Age? *

Breed? *

Sex? *

Is the dog pregnant? *

Is the dog in heat? *

Weight? *

Is this dog up for adoption? *

If the dog is up for adoption, please explain why. If the dog came to you through a shelter or rescue, please provide the name of the shelter or rescue from which you received the dog. *

Medical History

Name of Veterinary Clinic *

Veterinarian's Name

Address *

Phone *

Is the dog up to date on its rabies vaccination? *

Are there circumstances that we need to be aware of (ie. termination of pregnancy, pediatric spay, undescended testicle, etc.) that would make the procedure more costly? If yes, please explain: *

BBR will pay the veterinarian directly. The maximum amount that BBR can pay toward any dog is $250. Any amount over $250 will be your responsibility. We ask that you contribute as much as you can, so that we are able to help as many dogs as possible.

Amount you will contribute *

Amount requested from BBR *

Additional Information

Have you applied elsewhere for financial assistance? *

If you have applied elsewhere for financial assistance, please let us know where, and how much you received. *

Have you applied previously with BBR for assistance? If so, when did you apply, and what was the result? *

How did you hear about BBR's spay/neuter assistance program? *

I give consent for BBR to use this dog's name, location and photo for fundraising and promotional purposes. *

Yes

No

Please upload a photo of the dog needing assistance *

BBR asks that in exchange for this assistance that you "Pay it Forward" when you're able to in the future. Examples of this request are: Volunteering with us or your local animal shelter, donating to BBR's Medical Assistance Fund or another local spay and neuter initiative, such as Friends of Cats and Dogs (FCDF.org)

Do you agree to "Pay it Forward" in the future? *

BY TYPING MY NAME IN THE SPACE LABELED “SIGNATURE” BELOW (WHICH SHALL CONSTITUTE MY SIGNATURE) I CONFIRM THAT I HAVE READ AND UNDERSTAND EACH AND EVERY TERM SET FORTH ABOVE. *

Please note :

This application is ONLY for spay or neuter assistance, if you are looking for additional spay/neuter assistance please use the appropriate form.
We cannot reimburse for procedures that have already been completed.
All funding must be pre-approved and we only pay the vet clinic directly.
If you work for a clinic and have a client that is unable to fill out the application due to disability or lack of internet access, please contact us at fixabull@bamabully.org
If you haven't heard from us within 7 days of submitting your application, check your spam folder for our volunteer's response. The name you submit on the application will appear in the subject line.

FOR BBR USE ONLY:

Received by:

Date:

Approved: Denied: Amount:$

Funding Source/Grant Allocation:

Clinic used:

Comments: