Indy Pit Crew Spay Neuter Program Application
Answers marked with a * are required.
 
 
 
 
1. Please initial below that you have read and understand the mission of Indy Pit Crew: Through education and community outreach, Indy Pit Crew combats dog fighting, strives to eliminate pit bull over-population and encourages responsible ownership while inspiring a better understanding and appreciation for the American Pit Bull Terrier and all Pit Bull type dogs. *
 
 
 
2. Please check the boxes below acknowledging that you have read and understand the program guidelines.
*














      
 
 
 
3. Name: *
First
Last
 
 
 
4. At what address do you and your pets live? *
Street address
City
State
Zip code
 
 
 
5. Is the address entered above (living address) the same as your mailing address? *

      

 
 
 
6. If you answered NO above, please enter the address where you receive mail.
Street address
City
State
Zip code
 
 
 
7. Home phone number:
 
 
 
8. Cell phone number:
 
 
 
9. Work/Other phone number:
 
 
 
10. Email Address:
 
 
 
11. What is your GROSS annual household income?
This is the amount of ALL income brought into the home by ALL adults living in the home.
GROSS amount means this amount is calculated BEFORE taxes are taken out.
*
 
 
 
12. How many people are living in your home?
(Enter a digit in each block. Enter zero for none.)
*
Adults
Children
Students
Elderly
 
 
 
13. Can you afford to pay for some part of your Pit Bull's surgery? *





      
 
 
 
14. Are there other circumstances which we should take into consideration when reviewing your financial situation? Please note that proof of income or enrollment may be requested. Please select all options below which apply to you.








      
 
 
 
15. Please tell us about ALL of the Pit Bulls which you need spayed and/or neutered.
For EACH pet include the Pit Bull's name, sex (male or female), age, and breed.
You may only apply for dogs that you personally own.

Examples:
Pet #1: "Fido", Male, 3 years old, Pit Bull mixed with Lab
Pet #2:  "Princess", Female, 5 months old, Pit Bull pure bred
Pit Bull #1
Pit Bull #2
Pit Bull #3
Pit Bull #4
Pit Bull #5
If more than 5 write MORE
 
 
 
16. Please tell us if the Pit Bulls you need spayed or neutered are up to date on their required vaccines.

The required vaccines are: 5-in-1 (or 7-in-one), Bordetella (also known as Kennel Cough) and Rabies (sometimes good for 3 years, see your vaccination certificate for details).

To be considered up to date, you must have a vaccination certificate from the vet or organization who vaccinated your Pit Bull.  This vaccination certificate should include the date of vaccination and the expiration date of the vaccine.  If you do not have proof of vaccination in hand the day of your appointment, your pet will not be considered up to date on its vaccines.

Please complete the rows below like these examples:

Pet #1: "Fido": up to date on 5-in-1 and Bordetella, not up to date on Rabies
Pet #2:  "Princess" : no vaccines
Pet #3:  "Maggie" : up to date on Rabies (expires 2/2011), not up to date on 5-in-1 or Bordetella
Pit Bull #1
Pit Bull #2
Pit Bull #3
Pit Bull #4
Pit Bull #5
 
 
 
17. Can you afford to pay for your Pit Bull's vaccines?
Any required vaccines which your pet is not up to date on will be administered the day of surgery by the vet performing your pet's surgery.
Vaccines prices are:
5-in-1 : $10
Bordetella : $10
Rabies : $10



      
 
 
 
18. Local law requires that all pets have some form of owner identification on the at all times.
In addition to a well fitting collar and engraved ID tags, microchip identification is a permanent form of identification which can be used to locate you in the event that your dog is found stray.
The microchip is as small as a piece of rice and is injected just under your Pit Bull's skin between his shoulders. The injection procedure is no different than the shot your dog will receive for his vaccinations. Once implanted, the chip stays inside the animal for life.  In order for you to be contacted when your animal is found, you must keep in touch with the microchip company and update them any time that you move or change your phone number.   Indy Pit Crew provides microchips FREE to Pit Bulls and Pit Bull mixed breeds at our community events.
Are you interested in receiving a microchip identification implanted in your Pit Bull?
*


      

 
 
 
19. To qualify for the free spay/neuter surgeries, Indy Pit Crew requires a photograph or picture of each dog for which you are applying.

Your three options to submit the photograph(s) are:

1. Email
To email a photograph, attach the photograph to an email sent to the following address:
spayneuter@indypitcrew.org
Include your name, your pet's name and the date you completed your application on the subject line.  Please send one email per Pit Bull.

2. Mail
Send a printed photograph in an envelope to:
Indy Pit Crew    
PO Box 441807    
Indianapolis, IN 46244


On the back of the photograph write your name, the dog's name and the date you completed your application.

3. Attend an Indy Pit Crew event
Go to www.indypitcrew.org and review our event calendar (on the right side).
Attend the event of your choice, after arriving, check in with an Indy Pit Crew member and let them know that you need your dog's photograph taken to complete your application for free spay/neuter.

Please select which option you will use:


      

 
 
 
20. Please tell us about ALL the pets living in your home.
For EACH pet include the species (dog or cat), sex (male or female), name, age, breed, and if the pet is spayed, neutered or intact (neither spayed or neutered).
Examples:
Pet #1: Dog, Male, "Fido", 3 years old, Pit Bull mix, intact
Pet #2: Dog, Female, "Princess", 5 months old, Pit Bull, intact
Pet #3: Cat, Male, "Jake", 2 years old, Unknown Breed, neutered
Pet #1:
Pet #2:
Pet #3:
Pet #4:
Pet #5:
Pet #6:
Pet #7:
Pet #8:
Pet #9:
Pet #10:
 
 
 
21. Do you need assistance paying for spay or neuter for any of your other (non-Pit Bull) pets listed above?
If so, please select which animals (as numbered the same as the above question) you would like assistance for.








      
 
 
 
22. During the time that you have owned them, have any of your female dogs been pregnant or given birth to puppies? *


      

 
 
 
23. If you answered YES to question #22, please explain how your female dog got pregnant.


      

 
 
 
24. If you answered yes to the above question #22, please tell us how many times your female has been pregnant or had puppies since you have owned her.
 
 
 
25. Please check any of the items below which you would like to receive more information about.














      
 
 
 
26. Please read the following statements and check the box next to the statement acknowledging that you understand the guidelines of our spay/neuter program. *




      
 
 
 
27. Release of Liability *
      
 
 
 
28. In "signing" this waiver, I hereby release Indy Pit Crew or any of their affiliated organizations from any and all liability. *
Full name
Date
 
 
 
We appreciate your willingness to participate in this program in an effort to reduce the overpopulation problem Pit Bulls face and to do the responsible thing for your own pet.

Now that you have completed this application, you must email spayneuter@indypitcrew.org in order for the review process to begin.

We will review your application and determine which certificate level you qualify for (low cost or free).

Review of your application may take up to 2 weeks from the date of submission.

This program is sponsored in part by the Animal Farm Foundation in upstate New York.
Animal Farm Foundation's mission is to restore the image of the American Pit Bull Terrier and protect all dogs from discrimination and cruelty.
For additional information on Animal Farm Foundation and their programs or to learn how you can donate towards great programs like this one, please visit their website at  http://animalfarmfoundation.org/index.php .