PBRC Spay/Neuter Funding Application.
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    Please use two digits for month and day - 01-02-03-04-05-06.
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  • Log into Facebook, then click on your name in the upper right part of the screen. Copy the Facebook Profile URL in the address bar of your browser
  • If this is your personal dog please select owned. If the dog is currently with a rescue organization please select rescue organization.
  • Veterinary - Hospital - Clinic Information

    Where surgery will take place.
  • ***Please include
    Veterinarians Name
    Clinic Name
    Street Address
    City State Zipcode
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  • Contact a local low cost vet clinic in your area, request an estimate, scan or photograph and upload here.
  • Numeric

    Only complete the next 4 questions if your dog has been diagnosed with PYOMETRA. Otherwse, jump to the end of section and complete the rest of form.
  • End of PYOMETRA Section

    Continue completing the remainder of the form below.
  • In order to receive funding we must receive a clear, good quality close-up photo of the dogs's face and body. This upload allows for multiple photos.

  • Upload allows for multiple photos, if request is for Mom and pups or for more than one dog.
  • Name of Individual or group or Google search.
  • Section Break

    A description of the section goes here.