Pet Care Assistance Application

To apply for Pet Care Assistance, please complete and submit the form below.  As we review your eligibility, we will tell you where to send this additional information:

  • A signed application

  • Proof of Windham County residency (copy of driver’s license, passport, item of mail, etc.)

  • Proof of low income (Social Security / Disability benefits form, pay stub)

  • Completed Spay | Neuter Applications for any unaltered pets in home

Information about you
Name *
Name
Your date of birth
Your date of birth
Home phone
Home phone
Cell phone
Cell phone
Work phone
Work phone
Address
Address
Terms
With my signature, I certify that the information I have given is true. I understand pet care assistance is being provided to my pets, based on the information above. I understand in order to receive pet care assistance the following conditions must be met: - I am a resident of Windham County, Vermont - I will work with WCHS to have all my pets spayed or neutered - I will not acquire any more pets while I am receiving pet care assistance - I will inform WCHS if my financial status changes such that I no longer require assistance Along with this application, I will supply WCHS the following (please note, if these items are not included, you will not qualify for this program): - Signed copy of Pet Care Assistance Terms - Proof of Windham County residency (copy of driver’s license, passport, item of mail, etc.) - Proof of low income (Social Security / Disability benefits form, pay stub) - Completed spay/neuter application for any unaltered pets in home
I agree to the program's terms as enumerated above.
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Windham County Humane Society's Pet Care Assistance Program

Name *
Name