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Type of pet being spayed/neuteredDogCat

Will Name CHECK

Name *

First

Last

Address

City, State, Zip

Phone Number

Please include the area code

Email

Pet's Name

Pet's Age

Pet's Weight

Approximate

SexFemaleMale

Breed/Hair Length

Color

Coat color

Distinctive Marks

My pet lives…InsideOutsideBoth

My pet's temperament is…Easy to handleDifficult to handleThird Choice

Is your cat pregnant?YesNoUnsure

(The clinic does spay pregnant animals)

Has your pet recently had a litter?YesNo

Date litter was born:

(If applicable)

Current health issues and medications

Has your pet had any vaccinations?YesNo

If so, when and what?

Has your pet been tested for FIV/FELV?Yes – NegativeYes – PositiveNo

Will you be the one picking your pet up after surgery?YesNo

If not, please tell us who the pickup person will be

Please check any additional Services You Would Like Performed On Your Pet

• Feline Spay $80
• Feline Neuter $65
• Rabies 1YR or 3YR (Proof of 1YR Required) $15
• FVRCP (Distemper) $14
• Feline Leukemia $23
• FELV/FIV Test $40
• Ear Mite Treatment $12
• Tapeworm Treatment $15
• Revolt (Flea Treatment and Dewormer) $6
• Dewormer Only $5
• Cerenia Injection (Anti-nausea) (Weight Dependent, paid at pickup)
• Microchip $30
• E-Collar $12
• Ear tip (recommended for community cats) – Free

Release Form – PLEASE READ CAREFULLY AND CHECK EACH BOX

• I, acting as owner or agent of the pet(s) previously named, hereby request and authorize Tri-County Animal Rescue Center through whomever veterinarians designated 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, have no medical history available, and/or 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 Tri-County Animal Rescue Center’s veterinary agent may not perform a complete physical examination before surgery is performed. I also understand that my animal(s) will not receive pre-operative bloodwork and waive my right to have this service performed prior 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 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(s) is in good health and will not have any food or water from 12:00 midnight the evening prior to surgery
• I understand that Tri-County Animal Rescue Center’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 during surgery
• Any pet not claimed at the end of the day will be considered abandoned and appropriate action will be taken by Tri-County Animal Rescue Center
• Tri-County Animal Rescue Center’s designated veterinarians are unable to provide any post-surgical care. I understand that I will be responsible for any postoperative care at my expense. All surgeries are performed by a licensed, accredited veterinarian.
• I hereby release Tri-County Animal Rescue Center, all veterinarians, assistants, volunteers, directors, and employees from 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 TriCounty Animal Rescue Center liable for any damages caused during the transportation of the animal(s), or for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters or acts of God.

Electronic Signature

By signing above, you agree to electronically sign your name

Date

MM/DD/YYYY

Submit

Instructions – Please read carefully!

Please make sure YOU are the one available to drop off your pet on surgery day!
Application:

1. Complete the application in its entirety and submit it with payment to reserve a spot in one of our
   clinics. Clinic spots can only be reserved once payment is made. You will be contacted by a shelter
   volunteer to confirm which clinic you were assigned to. If the date you were assigned to is
   inconvenient, you can opt to be pushed back to a later date. Our clinics currently accommodate 12
   female spays and 12 male neuters. There is no guarantee that all your animals will be scheduled for
   the same clinic. Should this occur, you can choose to split them up between multiple clinics or wait
   for a clinic that can accommodate them all.
2. Applications can be submitted via email to contactus@tricounty-arc.org or mailed or dropped off in
   person at 9562 Route 322, Shippenville, PA 16254.
3. Payment must be received to reserve your spot and can be submitted via PayPal, check, money order,
   cash, or credit/debit card
   a. Feline spays are $80 (this includes the spay and transportation)
   b. Feline Neuters are $65 (this includes the neuter and transportation)
   c. Vaccinations, testing, and additional treatments can be ordered and should be included in
   your total.
   d. For pregnant females – please note that an additional $10 will be charged at pick up for
   pregnancies that are over halfway.
   e. There will be a $35 charge on any returned check
   f. If you are paying by check, you must provide a copy of your photo ID
   g. If you are bringing a cat in a trap and you do not know the gender, you must sign up and pay
   for a female spot
   Surgery Day:
4. Other than unknown pregnancy termination, hernia repair, or the procedure for undescended
   testicles, ALL pets should be at least 3 pounds 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. Tri-County Animal Rescue Center 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.
5. Drop-off time for your pet(s) will be approximately 6:00 am. Please allow 30 minutes for check-in.
6. You will need to sign the anesthesia consent form on this day!
7. Pick-up time will be anywhere from 3:00 pm- 6:00 pm the day of surgery. You will receive a phone
   call the day of surgery with the approximate time. Please make sure someone is available during this
   timeframe for pickup.
8. Any animal not picked up will be considered abandoned and appropriate action will be taken.
9. Pets should not have any food or water after 12:00 a.m. midnight the night before surgery.
10. All pets must be in their own personal carrier labelled with your name, cat name, and phone
    number. You may write directly on the carrier or use a piece of tape. Hard carriers are preferred.
11. Please line your carrier with newspaper or a towel/fabric that you won’t mind if we must throw it
    away. Do not put anything else in the carrier.
    For questions, please email contactus@tricounty-arc.org or call or text 814-913-2264

Thank you for helping with overpopulation!