"FIXES FOR FREE" GRANT APPLICATION

Made possible by a grant from the Maryland Department of Agriculture .
Online submissions: Please complete the online application below (do not print).
Print/Mail Submissions: Download and fill-out the form here: “Fixes For Free” Grant Application Form.

OWNER'S INFORMATION




YesNo



INCOME ELIGIBILITY INFORMATION


yesno

OR


DisabilitySSIUnemploymentFood StampsWelfareMedicaidWICSection 8 housing

You will need to provide proof of either your household income or any government assistance that you receive. Please attach a copy below:


ANIMAL INFORMATION

Please list all pets that you are requesting assistance for:

femalemale
catdog


femalemale
catdog


femalemale
catdog


femalemale
catdog


If any of the animals listed above have current vaccination records or are microchipped, please provide that information along with this application.


Once your application is approved you will be notified via your contact information.

I agree that my veterinarian may share the above listed animal(s) medical records with The Humane Society of Kent County MD, Inc.
I agree to indemnify and hold The Humane Society of Kent County MD, Inc. harmless from and against any and all liability arising from the performance of any of the procedures necessary to spay or neuter my pet(s).




Check here to indicate that you have read and agree to the terms above.