Thank you for your interest in fostering for the Humane Society of Carroll County! Please be sure to read all general information before requesting an appointment request. Surgery ScheduleType of Surgery(Required)Please Select a Surgery TypeCat SurgeryFemale Dog 5-40lbFemale Dog 41-80lbMale Dog 5-40lbMale Dog 41-80lbPreferred Date of Surgery (Cat)(Required)Please Select a Surgery DateMonday, December 22Preferred Date of Surgery (Dog)(Required)Please Select a Surgery DatePet InformationPet's Name(Required)Species(Required) Cat Dog Cat Breed(Required) DSH DLH Siamese Persian Himalayin Other Dog Breed(Required) Lab Golden Corgi German Shepherd Bully Breed Other Other Breed(Required)Age(Required)Please Select OneLess than 1 year (must be at least 3 months)1 year2 years3 years4 years5 years6 yearsPlease specify how many months your pet will be at the time of the surgery(Required)Sex(Required)Please Select OneMaleFemaleThis field is hidden when viewing the formBreedPlease note we are NOT able to accept brachycephalic dogs (such as English Bulldog, French Bulldog, Pug, Boston Terrier, Shih Tzu, Boxer, and Pekingese) at this time. Color(Required)Approximate Weight(Required)Please Select One5lbs-40lbs41lbs-80 lbsWe are unable to accept animals under 5 lbs or over 80 lbsOwner InformationOwner's Name(Required) First Last Email(Required) Phone(Required)Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Payment InformationDo you have a coupon code?(Required) Yes No Coupon(Required) Billing Address(Required) Same as Mailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Subtotal $0.00 Would you like to cover the fee we pay to process credit cards? Yes, add the credit card fee to my purchase Credit Card Fee Price: $0.00 The payment is non-refundable for missed appointments.Credit Card(Required)Configuration Required: To use the Stripe field, please configure your Stripe Settings. Total
