Spay Neuter Form | Tri-County Animal Rescue Center

Name

First

Last

Address

Street Address

City, State, ZIP

Phone Number

Please include the area code

Email pet and

Pet's Name

Pet's Age

Pet's Weight (approximate)

Male or Female?

Breed

Color

My pet lives…

My pet's temperament is…

Is your pet pregnant?

Has your pet recently had a litter?

If yes, date litter was born:

Current medications and health problems

Please list all medications your pet is taking and any current health conditions

Is your pet vaccinated?

If yes, please list vaccinations

Please provide a date of the vaccination if possible

PLEASE READ EACH BOX CAREFULLY BEFORE CHECKING

I, acting as owner or agent of the pet(s) previously named, hereby request and authorize Tri-County Animal Rescue Center (TCARC) through whomever veterinarians they may designate, to perform an operation for sexual sterilization of the animal(s) named on the application. I declare under penalty of perjury that I care for the pet(s) listed, and/or that I am properly authorized to present the pet(s) for the indicated surgery.
I recognize and understand the risks inherent to anesthesia and surgery, particularly for pet(s) that are pregnant, in heat, injured, sick, and /or have no medical history available, are ill or have heartworms. I understand the slightly higher risk inherent to the injectable anesthesia that will be used versus gas anesthesia. I understand that both types of anesthesia are acceptable forms of sedation. I understand that TCARC’s veterinary agent may not perform a complete physical examination before surgery is performed. I also understand that my animal will not receive pre-operative blood work and waive my right to have this service performed priior to surgery. By presenting the pet(s) for surgery, I accept the risks for any underlying health problem that would complicate recovery and/or survival from anesthesia and/or surgery.
I understand that my animal will be rabies vaccinated, at no additional charge, if I cannot provide proof of a current rabies vaccination. I understand that it takes up to two weeks for vaccinations to protect my animal. I understand the inherent risks of failing to maintain current vaccinations and waive all claims arising out of or connected with the performance of this operation due to such failure.
I certify that my animal is in good health and has had no food or water since 12:00 midnight the evening prior to the surgery
I understand that TCARC’s veterinary agent has the right to refuse service to any animal to whom surgery is deemed a health risk
I understand that if my animal is pregnant, the pregnancy will be terminated at surgery
Any pet not claimed at the end of the day will be considered abandoned and appropriate action will be taken by TCARC
TCARC’s designated veterinarians are unable to provide ANY post-surgical care. I will be responsible for any postoperative care at my expense. All surgeries are performed by a licensed, accredited veterinarian.
I hereby release TCARC, all veterinarians, assistants, volunteers, directors, and employees from any and all claims arising out of or connected with the performance of this procedure or any adverse reactions from vaccinations. Owner/agent hereby agrees to indemnify and not hold TCARC liable for any damages caused during the transporation of the animal, or for any damages caused by any unforseeable events including fire, vandalism, burglary, extreme weather, natural disasters, or acts of God.

Electronic Signature

By typing your name, you agree to use this electronic signature

Date

MM/DD/YYYY

Tri-County Animal Rescue Center Low Cost Pet Spay/Neuter Clinic Fee Schedule

DOGS: Male Neuter: $125.00 Female Spay: $140.00 (Prices include transportation to clinic)

There may be additional charges if your pet is pregnant. Please be prepared to pay any extra fees at the time of pick-up. Vaccines are available at an additional cost.

ALL SURGERIES MUST BE SCHEDULED IN ADVANCE. ALL SURGERIES MUST BE PRE-PAID. PAYMENT IS ACCEPTED BY MAIL OR IN PERSON WITH CHECK OR MONEY ORDER. THERE WILL BE A $35 CHARGE ON ANY RETURNED CHECK. A CURRENT PHOTO ID MUST BE PRESENTED. NO SURGERY WILL BE PERFORMED OR VACCINATIONS OR TESTS ADMINISTERED UNLESS PAID IN FULL IN ADVANCE.

Other than unknown pregnancy termination, hernia repair, or the procedure for undescended testicles. ALL PETS should be at least 20 weeks of age and in good health.

Pets must be dropped off and picked up in a proper animal carrier, preferably not made of soft material, with your name, address, contact information (including phone number) attached to the carrier. We reserve the right to refuse service if the animal is inappropriately confined.

Only one pet per carrier

Appointments:

When we receive your application with payment, we will assign you a surgical date.

FAILURE TO SHOW UP FOR YOUR APPOINTMENT WILL RESULT IN BEING MOVED TO THE END OF THE WAITING LIST.

Please be available between 3:00PM and 6:00PM to pick up your pet. Times may vary based on your pet’s recovery; you will receive a phone call when your pet is ready to go home.

Any pet not claimed at the end of the day will be considered abandoned, and appropriate action will be taken. It is the owner’s responsibility to be sure that any animal presented for surgery is clean and in good health. We strongly urge that your pet be examined by your regular veterinarian at least annually for vaccinations and preventative health care.

The staff reserves the right to refuse to perform surgery on any animal they deem as a poor surgical risk or for any other reason. TCARC and its veterinary agents are unable to provide ANY post-surgical care. You will be responsible for any postoperative care at your expense. All surgeries are performed by a licensed, accredited veterinarian.

Drop-off/Pick-up

Drop-off time: Drop-off time for your pet(s) will be at approximately 6:00AM. Please allow 30 minutes to check in.
Pick up: Please make arrangements to pick up your pet(s) between 3:00PM and 6:00PM the same day of surgery. You will receive a phone call late afternoon on the day of surgery with the exact time.

Day Before Surgery

PETS MAY HAVE NO FOOD OR WATER after 12:00 Midnight the night before surgery

Carrier

Please line your carrier with newspaper or a towel/material that you won’t mind if we have to throw it away. Do not put anything else in the carrier, such as toys or bowls, etc. A carrier for large dogs will be provided by the clinic.

Please label your carrier with your name and phone number. You may tape a piece of paper to the carrier or write directly on the carrier with permanent marker.

Clinic paperwork (application and surgical release form) must be turned in and paid in full before clinic date. There will be no refunds if you cancel or do not show up for the clinic. If you are paying by check, please bring your photo ID. We accept checks, money orders, and credit cards.

If you have any questions,

please call 814-918-2032 or

email spayneuter@tricounty-arc.org

Thank you for helping fix the pet overpopulation problem by fixing your pet!

For questions, email spayneuter@tricounty-arc.org or call (814) 918 2032

ALL applications must be received at least 7 days prior to the clinic date.