Animal Rescue Inc Medical Surgical Consent Form
ADVERTISEMENT
112/15
Animal Rescue, Inc. Medical/Surgical Consent Form
Spay/Neuter
Rabies
Distemper
Flea Treat.
Worm Treat.
Ear Tip*
*If you wish for this cat to be ear tipped, please initial the line above at your
Guardian
Address (No PO Boxes)
City
State
Zip
Phone
Alternate Phone
Animal’s Name
Breed (DSH, DLH)
Sex
Age
Color
Address where animal was found? _____________________________________
If you don't know the address, was it MD, PA, or other? _____
1. What time did your cat last eat?
am/pm
2. Does this cat have a current rabies vaccine (must show proof): Yes No
3. Is this cat kept: Indoors
Outdoors
Both
4. Is this cat in heat? Yes
No Unsure
5. Has this cat nursed kittens in the last ten days? Yes No Unsure
6. Would you like a free rabies tag? Yes No
Date:
Payment By:
Cost:
I am the Guardian or Guardian’s authorized agent of this animal and give permission to medically/surgically treat and/or surgically sterilize
him/her. In the event of injury or death to this animal, I waive all claims for damages against Animal Rescue, Inc., any veterinarian and any of
the officers or employees of these corporate entities. I also understand that I must pick up my pet on the day(s) indicated by Animal Rescue,
Inc. personnel. and failure to pick up within seven (7) days will be construed as abandonment which is punishable by a fine up to $1,000.00.
The animal will then be considered available for adoption. In addition to any fines, I will also pay a fee of $20 per day if my pet is not picked
up on the day and time that is designated by Animal Rescue, Inc. personnel.
Animal Rescue, Inc. Witness
Guardian
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal