Spay & Neuter Application

2. Garland County Sheriff Office - 525 Ouachita Ave. Hot Springs, AR 71901

4. Date*
   Date

6. First Name*

7. Last Name*

9. Address*

11. City*

12. State*

13. Zip Code*

15. Phone Number

16. Work Number

18. Email Address

20. Driver's License #*

21. State*

23. Proof of Residency*

    Energy provider bill. Bank statement. Tax assessment. Photographic ID. Mortgage statement. Certificate of voter registration.

25. Does animal have a current rabies immunization certificate?

    1. Yes
    2. No

26. Proof of Rabies Immunization

    Current Rabies Certificate If none, a rabies immunization will be required before a spay or neuter can be performed.

28. Species:*
    -- Select One --DogCat

29. Sex:*
    -- Select One --MaleFemale

30. Age:*

    Age of Animal

32. If Female, is the animal:

    1. In Heat
    2. Pregnant

33. If Cat, do you have access to a carrier:

    1. Yes
    2. No

35. Please bring this form to the above address. You will recieve a list of participating veterinarians and a voucher for $50.00 off the cost of a spay or neuter.

37. I swear/affirm that these answers are true and correct to the best of my knowledge

39. Signature*

40. Date:*
    Date:

Leave This Blank:


41. Print Only

* indicates a required field