Application for Income Eligible Spay/Neuter Fees

    Please review our program qualifications and requirements prior to completing this application.

    Qualification is income-based. A driver's license/picture ID, and proof of address (such as a utility bill) are required prior to receiving reduced fees, in addition to proof of income eligibility.

    About You

    *Required Field

    About Your Pet

    Dog

    *On your pet's scheduled surgery day, check-in is between 7:30 a.m. and 8:15 a.m. With that in mind, which day(s) would be most convenient for you?

    *Required Field

    Attestation of Household Income and Financial Hardship

    Select one method below

    In order to qualify for Napa Humane's low income fees, your household must meet one of the following criteria:

    Assistance Programs

    You or another person in your household is participating in one of these assistance programs:

    CalFresh/Food Stamps

    CalWorks/TANF

    WIC

    Free or Reduced Lunch

    Medi-Cal

    AT&T Lifeline

    COMBINED GROSS INCOME

    My household's income does not exceed the "very low income" limitations by household size as established by the California Department of Housing and Community Development for Napa County. To use this method, please attach a copy of your last tax return that shows gross income and number of household members. If you do not file income taxes, please submit three months of pay stubs per job per wage earner or use one of the options in Method 1.

    *Required Field

    Qualifying Documentation

    If submitting any form(s) containing Social Security Number(s), please block out the number(s) so they are not legible

    *Required Field

    Signature

    I declare under penalty of perjury under the laws of the State of California, that the above information is true and correct. I understand that this information is kept confidential. I also declare that I have not been convicted within the last five (5) years by any court of law for any violation of this chapter or any other law relating to animals, public nuisance caused by animals, or cruelty to animals in this or any other state.

    *Required Field

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