Your application will be on file for two months. If we do not receive a picture by that time, you application will be canceled.
Please note, this is a free Pit Bull \ Pit Bull Mix spay/neuter surgery program. Fix A Bull covers the surgery cost in full. There are costs that are optional to you if you choose, and those optional services will be offered at the animal hospital.
First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Cell Phone
Alt Email
Please tell us the total number of people that live in your household.*
Total Annual Household Income (choose one) [This is the income of the people combined in your household. Must be able to show proof of income]. * Choose one: $20,000 or under per year $20,001 - $30,000 per year $30,001 - $40,000 per year $40,001 - $50,000 per year $50,001 or over per year
How did you hear about the Fix-a-Bull Program?*
I have other pets (not Bully Breed) that need to be fixed. Please send me information on other low cost spay-neuter programs for other companion animals (dogs and cats). Choose one: Yes No
What is your dog's name?*
What is your dog's gender?* Choose one: Male Female
What is your dog's primary breed to the best of your knowledge*
What is the approximate weight of your dog (in pounds)?*
How old is the dog that you would like to get altered?*
Do you own the dog?* Choose one: Yes No
If you do not own the dog, please provide the name and contact information of the owner
Has this dog ever seen a vet?* Choose one: Yes No
If this dog has seen a vet, please provide the vet name and address
Has this pet received any vaccinations?* Choose one: Yes No
What vaccinations has this dog had in the last three years
Is your dog microchipped?* Choose one: Yes No
If this dog is a female, has she had puppies? Choose one: Yes No
If yes, what was the date of her last litter?
Female Dogs Only: If applicable, when approximately was your female dog's last cycle date?
Is your dog ok around other dogs and/or stangers?
How did you acquire this pet? Choose one: Adopted from a shelter/rescue group Found as a stray Given by a stranger (i.e. outside a store) Purchased from a breeder Given by a friend or family member Purchased at a pet store Kept from a litter Purchased from individual (i.e. Craigslist) Other
We like to hear more about where your dog came from. If you selected other or a rescue group. Please let us know the name of rescue or shelter and/or how your dog came into your family. *
I agree to have my dog wear a collar and leash (please no retractable leashes) when dropping off for surgery?
Would you be interested in volunteering with our group or help with a future fundraising event? If so, what would you be interested in helping with?
I am aware that if I am not able to provide 48 hours notice or do not show up to the appointment, I will be responsible for paying a $40 cancellation fee.* Choose one: Yes No
I certify that the information entered on this applicant is true, the dog is not up for adoption, and the dog is not part of a rescue group or shelter. Enter your Name and Date*