Cat Haven - Fix-A-Feline Form

"I purr, therefore
I am." - Anonymous

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Feral Program Fix A Feline Program

Health & Behavior Placing a Cat or Kitten Spay/Neuter Information Disaster Preparedness

The Fix A Feline program has been created for cat owners and caretakers with genuine financial need. To be eligible to receive a free spay/neuter certificate, please complete the form below or submit your application by mail. Click Here for a printable version of the Fix A Feline application in Adobe Document format. If you do not have Adobe Acrobat Reader, click here to download a free version from Adobe systems.


Cats to be spayed or neutered (limit 2 per request):
Cat One* Male Female Name Age		Cat Two Male Female Name Age

First Name:*
Last Name:*
Address:*
City:*
State:*
Zip:*
Home Phone:*
Work Phone:
Cell Phone:
Email Address:*
What is the best time to reach you?
Which method would you prefer a Cat Haven representative use to contact you?
How many people in your household?*
How many cats in your household?*
How many dogs in your household?
Who is your current veterinarian?*
Have you checked with your current vet for a price quote on this surgery?*		Yes If Yes, the price was $ No
What amount of money (if any) can you afford to pay (per animal) toward the spay/neuter procedure?
Total annual household income:*		$
Please describe your financial situation, checking ALL applicable boxes:
	Own Home		Rent
	Retired		Medicaid
	Public Assistance		Food Stamps
	Single Income		Double Income
	SSI		Unemployment Compensation
	Section 8		Aid to the Aged, Blind, Disabled
	Aid to Families with Dependent Children		Hurricane Katrina or Rita
Please add any other information that will help explain your need for funding:
If we are able to help you spay/neuter the animal(s) listed above, how many fertile animals will remain in your household?*
How did you hear about this program?*

I hereby certify that the foregoing information is true and correct and that I have not omitted anything that would make my application false or misleading. I have read and understand the attached information and instructions and agree to abide by them.
Check here if you accept the terms above Date*

Please click the submit button only once as it may take a moment for your submission to process.
		*All fields with an are required.**

P.O. Box 86231 • Baton Rouge, LA 70879-8231 • (225) 346-4238