TOWN OF AMHERSTBURG 2018 APPLICATION FOR SPAY OR NEUTER VOUCHER

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Philippa Blankenship
5 years ago
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1 TOWN OF AMHERSTBURG 2018 APPLICATI FOR SPAY OR NEUTER VOUCHER The 2018 Spay and Neuter Program allows for 90 Vouchers to be issued on a first come first serve basis for residents residing in the Town of Amherstburg. Spay and neuter vouchers have a maximum value of $50.00 inclusive of HST and will be limited to two per applicant or two per family. Any costs in excess of $50.00 for spay and neuter surgeries are the responsibility of the caregiver. Several veterinarians in Windsor and Essex County have chosen to participate in providing spay and neuter services, a complete list of participating veterinarians forms Appendix A of this application. To obtain information regarding the cost of spay and neuter services, applicants are asked to contact the veterinarians directly. Applicant Information First Name: Last Name: Address: Postal Code: Phone: Alternate Phone: Feral Cats to be Spayed or Neutered Number of vouchers you are applying for as a caregiver of a feral cat: (Maximum of two vouchers)

2 Applicant Identification The applicant named in this application must present photo identification at the time of submitting an application for spay or neuter vouchers in accordance with the program requirements. Valid photo identification is required for purposes of identifying the applicant as the rightful owner of a Town of Amherstburg spay or neuter voucher when obtaining spay or neuter services from the Veterinarian. Acceptable pieces of photo ID include: Ontario Driver s Licence Canadian Passport Canadian Citizenship Card Secure Indian Status Card Canadian Armed Forces Identification Card Permanent Resident Card At the time of submitting an application to the Town of Amherstburg, applicants will be required to produce identification which displays their address for purposes of identifying their residence as being located in the Town of Amherstburg. Signature The information I have provided is complete and true. I am at least 18 years of age, my residence in the Town of Amherstburg is my primary residence. I understand that if I do not sign my application, the unsigned application will be returned to me unprocessed. I understand that vouchers are issued on a first come, first serve basis and that they will expire 90 days from the date of issue by the Town of Amherstburg. If I am unable to use any voucher(s) issued to me within 90 days of the date of issue, I will advise the Town of Amherstburg prior to expiration of the 90 day period. Applicant s Signature: Date (mm/dd/yyyy):

3 The complete application form must be submitted in person at the following address: Town of Amherstburg 271 Sandwich Street South Amherstburg, Ontario N9V 2A5 Questions regarding the 2018 Spay and Neuter Program may be directed to the Licensing and Enforcement Division at the Town of Amherstburg at ext For Office Use Only Home Owner Tenant Roll Number: Meets all Criteria: Number of Vouchers Requested: Voucher # Issued: Voucher # Issued: Zone: Verified By: Voucher Expiry Date: Voucher Expiry Date: The personal information being collected on this Application for Spay or Neuter Vouchers is being collected for the purpose of determining eligibility under the 2018 Spay and Neuter Program of the Town of Amherstburg. The information collected is under the authority of the Municipal Act, 2001, and in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection, use and disclosure of this personal information may be directed to the Clerk at 271 Sandwich Street South, Amherstburg,, N9V 2A5 or

4 Appendix A 2018 Spay and Neuter Program Participating Veterinarians Name Address Phone Number Ambassador Animal 1345 Tecumseh Rd. West, Windsor Amherstburg Animal 220 Seymour St Amherstburg, Belle River Animal 576 Broadway, Box # 1266, Belle River Brack Animal 2621 Howard Ave. Windsor, Cat of Windsor 1277 Grand Marais Rd W, Dougall Ave. Veterinary 3020 Dougall Ave. Unit 13, Downtown Veterinary 154 Tuscarora St., Windsor, Emeryville Animal 106 Emery Drive, Emeryville, Erie Veterinary 102 Talbot St. West, Leamington, Essex Animal 355 Talbot St N, Essex Harrow Animal 110 King St W, Harrow Huron Church Animal 1797 Huron Church Road, Lakeside Animal 19 Division St N, Kingsville, Lauzon Veterinary 1315 Lauzon Rd. Windsor, Leamington Animal 35 John St, Leamington, Lesperance Animal 1046 Lesperance Rd Tecumseh, Rivard Animal Tecumseh Rd E, Windsor South Howard Animal 7250 Howard Ave. Oldcastle, Town and Country 2055 Sandwich W Parkway, Animal LaSalle, Talbot Street Animal 48 Talbot St. South Essex, Windsor/Essex County Humane Society Veterinary 1375 Provincial Rd. Windsor,

2018 Spay and Neuter Voucher Program Application for Spay or Neuter Vouchers

2018 Spay and Neuter Voucher Program Application for Spay or Neuter Vouchers Voucher Number: Expiry Date: 1. General Program Information A Spay and Neuter Voucher Program for cats was approved by Tecumseh