Completing this form will help volunteers get you registered quickly and correctly. If you prefer to register by phone, call 605-593-5550.

Tell Us About Yourself

What is your name?


What is your house number and street? (can be provided by phone)

City/town?

State?

Zip?

What is your e-mail address? *REQUIRED

What is your telephone number? *REQUIRED
(We need your telephone number to call with instructions
and to remind you of your clinic appointment.)

How many cats do you have?
Select... 1 2 3 4 5 6 7 8 9 10-20 21-30 30 or more

Are your cats feral or domestic?
Select... Domestic Feral Both Feral and Domestic

How many of your cats need to be fixed?
Select... 1 2 3 4 5 6 7 8 9 10-20 21-30 30 or more

How many of your cats will attend this clinic?
Select... 1 2 3

Tell Us About Your Cats

Cat 1

What is your first cat's name?

What is your first cat's gender?
Select... Male Female Feral or Unknown

How old is your first cat (approximately)?
Select... Between three and six months old Between six months and one year old Between one and two years old Between two and three years old between four and four years old Between four and five years old Between five and seven years old Between seven and nine years old Ten years old or older Feral - unknown age

What is the predominant color of your first cat?
Select... Black Brown Gray Orange Calico Tiger-Stripe Tuxedo White Feral - color to be determined when trapped

What is the approximate weight of your first cat? (minimum weight 2 lbs.)
Select... 2 to 4 lbs. 4 to 6 lbs. 6 to 8 lbs. 8 to 10 lbs. 10 to 12 lbs. 12 to 14 lbs. 14 to 16 lbs. 16 to 18 lbs. 18 to 20 lbs. Over 20 lbs. Feral - weight will be determined when trapped

Cat 2

What is your second cat's gender?
Select... Male Female Feral or Unknown Not Applicable - I am fixing only one cat

How old is your second cat (approximately)?
Select... Between three and six months old Between six months and one year old Between one and two years old Between two and three years old between four and four years old Between four and five years old Between five and seven years old Between seven and nine years old Ten years old or older Feral - unknown age

What is the predominant color of your second cat?
Select... Black Brown Gray Orange White Calico Tiger-Stripe Tuxedo Feral - color to be determined when trapped

What is the approximate weight of your second cat? (minimum weight 2 lbs.)
Select... 2 to 4 lbs. 4 to 6 lbs. 6 to 8 lbs. 8 to 10 lbs. 10 to 12 lbs. 12 to 14 lbs. 14 to 16 lbs. 16 to 18 lbs. 18 to 20 lbs. Over 20 lbs. Feral - weight will be determined when trapped

Cat 3

What is your third cat's gender?
Select... Male Female Feral or Unknown Not Applicable - I am fixing fewer than three cats

How old is your third cat (approximately)?
Select... Between three and six months old Between six months and one year old Between one and two years old Between two and three years old between four and four years old Between four and five years old Between five and seven years old Between seven and nine years old Ten years old or older Feral - unknown age

What is the predominant color of your third cat?
Select... Black Brown Gray Orange White Calico Tiger-Stripe Tuxedo Feral - color to be determined when trapped

What is the approximate weight of your third cat? (minimum weight 2 lbs.)
Select... 2 to 4 lbs. 4 to 6 lbs. 6 to 8 lbs. 8 to 10 lbs. 10 to 12 lbs. 12 to 14 lbs. 14 to 16 lbs. 16 to 18 lbs. 18 to 20 lbs. Over 20 lbs. Feral - weight will be determined when trapped

Now Just a Little More About You

Does someone in your household receive assistance such as food stamps, Medicare or housing assistance? We use these income guidelines to qualify you, but you don't need to get aid to qualify. Check your income eligibility here: http://doh.sd.gov/wic/eligibility.aspx
FERAL CAT OWNERS ARE EXEMPT FROM INCOME REQUIREMENTS.

I qualify as a feral cat caretaker or low-income client:
Select... Yes No

Can you afford a co-payment ($35 females/$25 males)?
Select... Yes No

I have read the terms and conditions and I agree to them. *REQUIRED
Yes, I agree

You will receive an e-mail and a phone call from a Coalition Volunteer. If you do not receive a confirmation e-mail or a telephone call, please call 605-593-5550 during business hours to register by phone.

By clicking "submit," you acknowledge that the information you have provided is correct and that you will speak to a Coalition volunteer to confirm your appointment.