Community Services Sign-Up Thank you for your interest in supporting pets and people in need. Please complete the following form to outline your clinic’s availability, capabilities, and preferences for participation in CHS-led Community Clinics. Clinic InformationClinic name(Required)Name of primary contact(Required) First Last Email(Required) Phone(Required)Please select the type(s) of care your clinic is willing to provide through Community Clinics(Required) Spay/neuter Wellness examinations Vaccinations All of the above Indicate your preferred method for offering client appointments(Required) Specific dates Number of appointment spots Please list specific dates below(Required)Please indicate the months you would like to participate(Required)Would you consider offering additional dates during high-demand periods?(Required) Yes No Maybe CapacityPlease specify the total number of animals you can accommodate per clinic date or offering window:Dogs(Required)Large Breed Spays/Neuters (mandatory)(Required)Cats(Required)Species specefic notes or limitationsAdditional Acceptance CriteriaAre there any additional restrictions your clinic would like us to consider when assigning clients? Temperament (e.g., reactivity limitations, etc) Size limits Age/medical requirements Other Please describe(Required)Willing to offer discounted rates to expand access?(Required) Yes No Maybe Preferred payment method Cheque E-Transfer (EFT-form must be completed) Media ParticipationWould you permit CHS to collect photos and/or media stories at your clinic AND/OR allow media partners to be present?(Required) Yes - CHS comms & media partners Yes - CHS comms only No On a case by-case basis Clinic Media Contact (If Different From Above)Name First Last TitlePhoneEmail RecognitionCHS will recognize participating clinics in marketing materials, newsletters, and online features. Do you wish to participate in our recognition and marketing program?(Required) Yes No Let's discuss Feedback & CollaborationAre you open to quarterly surveys or check-ins to improve the program and service delivery?(Required) Yes No Would you like to be involved in future conversations about program development?(Required) Yes No Additional comments or notesPlease include any final notes, questions, or special considerations CAPTCHA