Spay, Neuter and Vaccination Program Application
When funds are available, the Colton Baschke Foundation may be able to assist qualified low-income residents with the cost of having their dog or cat spayed/neutered or vaccinated. The low income guidelines can be found on our website. 

At the Colton Baschke Foundation one of our missions is to eliminate pet
overpopulation.
To qualify for assistance you must answer all questions and provide proof of income for all adults
living within the household.
a Proof of income should be ONE of the follow¡ng:

1. Most recent tax returns.
(Please be sure to use white out or black marker to hide social security numbers)

2. Documentation verifying low-income assistance form from a federal, state or city program.
  • Please note - We do not share your information with anyone.
  • We offer assistance for up to two pets (dogs or cats) per household 
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Full Name: *
Address: Please include your city, state and zip code *
Email: *
Phone Number: *
Pets Name: *
Dog or cat: *
Is their Rabies Vaccine current? *
What veterinarian do you use?  *
What is your current financial situation? *
How will this program benefit you? *
What is your household's total monthly income? Please include all sources. *
How many adults live in your home?
How many children live in your home?  *
Which of the following benefits do you receive? Please select all that apply. *
Required
The Colton Baschke Foundation assumes no responsibility if injuries, illness, or death should occur to your pet. By signing this application, you certify that the information above is true to your best knowledge and you understand that you may be subject to legal and disciplinary action in the event that the above facts are found to be falsified. 

Please type your signature below agreeing to the terms above. 
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Date of Application: *
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Please select which proof of income you will be submitting. 
After you have completed this application, please email your proof of income in order for your application to be complete. We will not be able to process the application without it. 
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