Alter Frederick Application

This program is to assist Frederick County residents on a limited income. All surgeries will be performed at Prospect Veterinary Clinic. A $30 co-pay is paid to FCHS.

Name
First Name
Last Name
Email
Address
Street
Address line 2
City
Zip Code
Country
State
Phone Number
Number of adults in your household
Number of children in your household
Maximum income for program participation is based on the 2016 United Way ALICE Income guidelines, with consideration of income needed to care for a pet:
Which of the following Proof of Income will you be including with your application?
Upload proof of income here
Pet's Name
Species
Sex
Age
Breed
Has your pet had all of its recommended shots?

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Well Care Assistance Program

This program is to assist Frederick County residents on a limited income with needed basic vet care for pets, some restrictions apply. FCHS will provide the client with a voucher for up to $175, with a $25.00 co-pay due when you apply. Please be aware the voucher can only be used for well care office visit, vaccines and/or tests. The $25.00 co-pay can be in the form of cash, money order or credit card.

Name
First Name
Last Name
Address
Street
Address line 2
City
Zip Code
Country
State
Phone Number
Email
Number of people in your household
Maximum income for program participation is:
$26,000 for household of one
$35,000 for household of two
$43,000 for household of three or more (call for additional information)
Income from all household occupants is taken into consideration to determine grant reward
Pet’s Name
Species
Sex
Age
Breed
Has your pet had all of its recommended shots?
What veterinarian will you use?

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Shanklin Senior Well Care

Shanklin Fund for Seniors Program Application

This program is for Frederick County residents age 65 or older on a limited income, to assist with needed pet care. Maximum income for program participation is: $26,000 for household of one; $35,000 for household of two; $43,000 for household of three. Income from all household occupants is taken into consideration to determine grant reward.

Name
First Name
Last Name
Phone Number
Address
Street
Address line 2
City
Zip Code
Country
State
Email
Your Age
Number of people in your household
Proof of Income (select which you will upload)
Proof of Income Document Upload here
Pet's Name
Species
Sex
Weight (approx.)
Age
Breed
Has your pet had all of its recommended shots?
What veterinarian will you use?

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Pet Overpopulation

Pet Overpopulation Prevention Program

The Frederick County Humane Society has partnered with local participating veterinarians to offer spay/neuter services at a reduced fee to Frederick County residents who qualify. Each household is permitted to process two pets through the program each year.

Name
First Name
Last Name
Address
Street
Address line 2
City
Zip Code
Country
State
Phone Number
Email
Number of people in your household
Total household gross income from all sources
To qualify for the program you must be a Frederick County resident who’s Total Annual Household Gross Income is within the Eligibility Guidelines. “Total Annual Household Income” includes income from all household members and sources. “Maximum Household Income” is determined by the number of household members:
What proof of income do you have
Upload Proof of Income here
Pet Name
Species
Sex
Age
Breed
Which of our “Participating Veterinarians” will you be using?
Payment Method; The fee for spay/neuter surgery is: $30
For payment by credit card:
POP vouchers expire within 30 days of issuance.

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Alter Frederick Application

Well Care Assistance Program

Shanklin Senior Well Care

Pet Overpopulation

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