ResQ Fund Application for Spay/Neuter & Wellness

Please check the boxes that best represent the reason for your application:

If you are requesting financial assistance, please explain your current situation and why you are requesting assistance through the ResQ Fund. Please include information regarding your current job status or recent change(s) to your income which have led you to need assistance at this time. Applicants must demonstrate a financial need to qualify for assistance.

Please check answer which best describes your current employment status:

Do you currently receive any Human Social Service Assistance? Check all that apply:

If you are receiving any of the benefits referenced above, please upload one document showing proof of financial need, such as unemployment status, disability, social security, SNAP benefits, etc.

If you are applying for spay/neuter assistance and are on government assistance, you may be eligible for 100% coverage of costs related to the surgery and rabies vaccine through the WV Spay and Neuter Grant program administered by the West Virginia Department of Agriculture which offers free spay/neuter services and an accompanying rabies vaccine.

If you think you are eligible, please sign below to give us your consent to fill out the Low-Income form on your behalf. A copy of this form can be found on our website at www.totheresq.org. If you do not believe you are eligible, please skip to the next question.

We aren’t always able to award 100% of the costs of services needed. For some awards, we may only approve a partial award. Are you willing or able to contribute a small percentage towards these services? If so, how much can you afford at the moment?

Which range below best reflects your monthly income from all sources in your household?

Please enter the total number of persons in your household for whom you are responsible, including yourself.

Is there anything you would like to share with us about your pet or why you need our help that you feel would be beneficial for our decision team to know when deciding your application?

Please let us know in the space below the total number of pets in your household. Please include ALL the pets in your household. For example, 2 dogs, 4 cats, 2 birds, 1 turtle etc. If you are asking for help with feral cats that do not belong to you, please indicate that and skip all personal questions.

Provide the name(s) for EACH pet for which you are applying for assistance. Include Type/Name/Sex. If you are asking for help with feral cats that do not belong to you, please indicate that and skip all personal questions.

For what type of medical services do you require assistance? Please check all that apply.

If you are applying for a dog to be spayed or neutered, approximately how much does your dog weigh?

Are all of your pets up to date on rabies vaccinations?

All pets must be living in a healthy environment and good living conditions. Please check the answer that best represents your pet's living environment.

To be approved to receive ResQ Funds, we require ALL pets in your household to be spayed/neutered, unless there is a compelling reason why they cannot be. Please check the answer below that best applies to your situation.

Are your pets kept solely for companionship, or are they part of a breeding program, or used for gaming, sporting, or similar activities?

Please use the space below to clarify questions above or to share any additional information that you would like for the ResQ Fund team to know when considering your application. If you have any questions, please also include them here.

If you do not receive help with your pet(s), what will you do?

Do you have transportation to get your pets to the vet? Please note that our volunteer transport service is ONLY available for rescues and unfortunately cannot be used for personal pets.

Have you applied for/requested/picked up any coupons or discounts through organizations like Animal Welfare Society of Jefferson County or Spay Today?

When your situation improves would you consider donating to us to help us continue to offer this assistance to those like you in need?

If you are applying for help with feral cats, do you require assistance with trapping them?

May we text you?

Do you object to having your name checked through the local court system?

If you have a veterinarian, do you give us permission to contact them for a reference, if one is needed. If yes, please enter the name and telephone number of the veterinary practice that you are currently using. If you do not have a veterinarian, please indicate below.

Please indicate your agreement to the following: I understand that the ResQ Fund may NOT cover all veterinary charges for my pet's care. If donations from the ResQ Fund are insufficient to cover the entirety of my pet's charges, I understand that these charges are my financial responsibility, and not that of The ResQ Fund or To The ResQ.

If the cat you are bringing for spay/neuter assistance is pregnant, do you understand and agree that the cat will still be spayed unless the veterinarian determines that the procedure would be unsafe for her?

I give my consent for volunteers and veterinary staff to transport, hospitalize, anesthetize, and perform spay/neuter and other necessary medical services on my cat/dog, including but not limited to vaccinations, parasite treatment, and basic medical care. I understand that all medical and surgical procedures carry inherent risks, including but not limited to anesthesia complications, allergic reactions, seizures, injury, or death. I acknowledge that these risks exist even when reasonable care is used.

I understand that the clinic providing services may not perform pre‑anesthetic bloodwork or advanced diagnostics, and I accept all risks associated with these limitations. I agree that I am responsible for any costs related to complications, follow‑up care, or additional treatment recommended by the veterinarian.

By signing below, I release and hold harmless To The ResQ, The ResQ Fund, their volunteers, representatives, transporters, and any partnering veterinary providers from any and all claims, demands, liabilities, or damages arising from or connected to the transport, treatment, or outcome of my pet’s care, except in cases of proven gross negligence or intentional misconduct as required by law.

Signing my full name below indicates my understanding of these risks and my agreement to the terms and release stated above.

I understand that it is my responsibility to accurately complete all required forms and to verify all requested services directly with the veterinary provider at check‑in. If I do not complete the forms myself, or if information is missing, unclear, or incorrect, I acknowledge that To The ResQ and The ResQ Fund are not responsible for any errors in services selected or omitted, including but not limited to ear‑tipping, vaccines, microchips, or other procedures.

I agree that any services performed beyond those pre‑approved by The ResQ Fund — including but not limited to CPR, emergency interventions, diagnostics, or additional treatments — are my sole financial responsibility. I understand that The ResQ Fund does not cover CPR under any circumstances.

By signing below, I accept full responsibility for verifying accuracy at the veterinary office and release To The ResQ, The ResQ Fund, and all representatives from liability for any discrepancies, omissions, or additional charges resulting from my failure to review or confirm services.

By signing below, I certify that the above information is true, and I understand that providing false information may result in nullifying this application. I understand that this application does not constitute that any services will be rendered. I understand The ResQ Fund has the right to deny any application. Signing my full name below serves as my signature and my certification of truthfulness of the statements I have made above and my agreement to all questions as answered.

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