Any Additional Information
Please note: Mountain View Humane's Vaccination Clinic Aid Application funds are only available one time per year, per pet.
Required: It is state law that your pet's rabies vaccination be current or updated at the time of receiving services.
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I HEREBY GIVE MOUNTAIN VIEW HUMANE CONSENT TO COMMUNICATE WITH ANY OTHER PERSONS OR PARTIES CONCERNING MY HISTORY FOR THE PURPOSE OF VERIFYING THE INFORMATION ON MY APPLICATION. I CERTIFY THAT THE ABOVE NAMED ANIMALS ARE OWNED BY ME PERSONALLY. IF APPROVED, I WILL BE NOTIFIED BY MOUNTAIN VIEW HUMANE. I UNDERSTAND THAT I WILL BE RESPONSIBLE FOR PAYMENT OF ANY AMOUNT ABOVE THE VACCINATION CLINIC ASSISTANCE.
Applicant signature: Date:
53 West Main Street, Christiansburg, VA 24073 (540) 382-0222