Low Cost Spay and Neuter Program
Spay and Neuter Program Owner Application & Consent Form
Fill out completely and mail form to: Friends of Guthrie Animals, Inc., P.O. Box 1557, Guthrie, OK 73044-1557. For more information call: Von Coburn (405)282-1520. Your application will be processed and you shall receive a spay/neuter voucher with the FOGAS seal by mail.
Please submit one application per animal.
Owner’s Name: _______________________________________________________________________________________
Daytime Telephone: _________________________ Evening Telephone: _________________________
Address: _____________________________________________________________________________
County: ___________________ City: ____________________________ State: _________ Zip: _____________
What is your household’s total income? $_________________ per _____ wk _____ mo _____ yr
How many people live in your household? __________ How many pets do you have?______________
SPECIAL CIRCUMSTANCES, complete the application and tell us why you need our help: ___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Animal’s Name: ________________________________________________ Circle: Dog or Cat
Breed: __________________________________ Circle: Male or Female Age: ______ Weight: _______
Proof of residence may be required. Proof of income may be required.
Please allow 2 to 4 weeks for your approval to be mailed to the above address that you provided on this application.
Oklahoma Law requires all dogs / cats to be vaccinated for rabies.
Proof of current rabies vaccination must be shown to Vet at the time of surgery or you will be charged for the Vet to administer the vaccination.
I give consent and authorize surgical sterilization of my pet and I understand the procedure. I also understand there are certain risks and complications associated with any operation or procedure of this type. I further understand that, during the course of the surgery, unforeseen conditions may arise that may necessitate the performance of additional procedures. I agree to pay the co-payment of $10.00 (ten dollars) to the participating veterinarian at the time of surgery and agree to have the surgical procedure performed within 30 days of FOGAS approval date. I am the legal owner, or agent for the owner, of the animal described above and I have the legal authority to execute this consent agreement. The above information is true and correct to the best of my knowledge.
Owner/Agent’s Signature: _____________________________________________ Date: ________________
Choose a Participating Veterinarian:
Crosstown Veterinary Services 2102 W. College Guthrie, OK, 73044 405-282-3443 [ ]
Guthrie Pet Hospital 123 W. Harrison Guthrie, OK 73044 405-282-8796 [ ]
Southpointe Veterinary Clinic 3106 S. Division Guthrie, OK 73044 405-282-2396 [ ]
Veterinary Corner 2930 Hwy. 105 Guthrie, OK 73044 405-282-4821 [ ]