| First Name: |
|
| Last Name: |
|
| Address: |
NO PO Boxes
|
| City: |
|
| County: |
|
| Home Phone: |
- -
|
| Work Phone: |
- -
|
Are you over
the age of 21?
|
|
Annual household Income:
|
|
Total number
of cats at residence:
|
|
Number of female cats to be spayed:
|
|
Number of
male cats to
be neutered:
|
|
Do you currently receive state or federal financial aid?
|
|
How did you
hear about
the Sundance Ranch?
|
|
The cost of the program to Curry and Roosevelt county residents is from $30.00 - $65.00 (50-80% savings) per animal depending on a) male or female and b) household income.
Proof of residency and household income required prior to approval.
|
|
|
