Certificate Of Exemption From Rabies Vaccine Template (Page 2 of 2) in pdf

Certificate Of Exemption From Rabies Vaccine Template Page 2

Name of Veterinarian (Print)

License Number

Address

Signature of Veterinarian

Date

This Certificate is valid until _______________ (not to exceed one year from date signed).

By signing below, I acknowledge that I am the owner of the animal described above. I have been informed that this

animal is exempt from rabies vaccination for a period of up to one year. I have also been informed of the following

important information:

•

This animal must be re-examined by the expiration date listed above. At the time the animal must either be

vaccinated against rabies or, if exemption status still applies, a new certificate must be issued.

•

Once the duration of immunity from the last rabies vaccination has lapsed, this animal is not protected

against rabies and, as a result, is at increased risk of becoming infected if exposed to a rabid animal.

•

It is recommended that the animal be closely observed when outside, walked on a leash and not allowed to

run at large. Prevent the animal from coming into contact with suspect rabid animals such as raccoons,

skunks, foxes, groundhogs, bats and free-roaming cats.

•

Exemption from rabies vaccination does not exempt the animal from other laws related to rabies. If this

animal is exposed or suspected to be exposed to rabies (e.g., due to a bite or exposure from a rabid or

suspect rabid animal), the Health Officer will require it to be euthanized or quarantined for six months. If

this animal potentially exposes a person to rabies (by bite or other means), it must be quarantined for 10

days and in a manner prescribed by the Health Officer

Date Signed

Date

A copy of this certificate must be provided to the owner of the animal listed above and kept as proof of exemption. A copy of this

certificate shall be maintained by the veterinarian for a period of one year from the date of issuance.

A copy of this certificate shall be provided to the Department of Public Health within (7) days of issuance.

ADPH February 2010

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Certificate Of Exemption From Rabies Vaccine Template Page 2