Pit Bull Rescue Central
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The PBRC website is a virtual shelter and resource for owners and caretakers of American Pit Bull Terriers, American Staffordshire Terriers, Staffordshire Bull Terriers, and pit bull mixes.

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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 PBRC 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.

PBRC's own spay/neuter page - http://www.pbrc.net/speuter.html
Friends of Animals - http://www.friendsofanimals.org/spaying/cover.htm
Pets 911 - http://www.pets911.com/services/spayneuter/index.php
Spay USA - http://www.spayusa.org/

Be sure to check with your local shelters and animal control facilities - many times they may know of additional resources in your area.

We can not reimburse for surgeries 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 pbrc-sn@googlegroups.com

If you haven't heard from us within 3 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.

Name of dog’s owner or primary caretaker:
Address:
City:
County of Residence:
State or Province:
Please enter numbers only in this field
Zip/Postal Code:
Email (please use an email address you are able to check often):
Please enter numbers only in this field
Phone number:



What is your dog's name?
What is your dog's age?
What is your dog's weight (lbs)?
What is your dog's gender?
Male Female
What is the breed of your dog?
Do you own the dog?
How long have you had the dog?
Is this dog up for adoption?
Yes No
If applicable, what is the name of the rescue or shelter that will place this dog?



Veterinarian's name:
Veterinary hospital or clinic name:
Address:
City:
State or Province:
Please enter numbers only in this field
Zip/Postal Code:
Please enter numbers only in this field
Phone number:
Please enter numbers only in this field
Fax number:
Contact name:
Please enter numbers only in this field
Total cost of surgery:
Please enter numbers only in this field
Amount you are willing to contribute:
Please enter numbers only in this field
Amount requested from PBRC:
Does your household receive any form of public assistance?
Yes No
If so, what?
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:
Have you contacted low cost spay/neuter resources for your area? If yes, please provide information on the results (If no, please see the resources listed above):
Do you have another application currently pending with us for additional medical assistance?
Yes No
Have you applied previously with PBRC for assistance?
Yes No
How did you hear about PBRC's spay/neuter assistance program?
I give consent for PBRC to use this dog's name, location and photo for fundraising and promotional purposes.

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