Spay & Neuter Assistance Program

Please note that in accordance with our mission, we will give priority to breeds and mixes that are commonly subject to breed bans.

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Name *

First

Last

Street Address *

City, State, & Zip Code *

Phone Number *

Email *

Household Annual Income *

• Under $25,000
• $25,000 – $49,999
• $50,000 – $74,999
• $75,000 – $99,999
• Other

What is your dog's name? *

What is your dog's age? *

What is your dog's sex? *

• Male
• Female

How much does your dog weigh? *

What is the assumed breed(s) of your dog? *

What is the name of your veterinarian's office? *

I acknowledge that dogs age 10+ must have a wellness exam completed and be cleared with vet prior to acceptance into program. *

• Yes

I acknowledge that due to high demand, my spay/neuter appointment is expected to be completed within 30 days. *

• Yes

Upon completion of my application, I will email a photo of my dog to iowansagainstbsl@gmail.com for social media and fundraising purposes. *

• Yes

I acknowledge that Iowans Against Breed Bans is solely responsible for the cost of the spay/neuter surgery. *

• Yes

is my Upon

By submitting this form, I understand and agree that Iowans Against Breed Bans is not liable for any complications resulting from veterinarian-provided services through this assistance program. *

• Yes

Submit