Scribd Logo
Upload

Welcome to Scribd!

  • CARA Spay Neuter Application Form

    Uploaded by

    Amanake
    26 views2 pages
    This document is a spay and neuter application form for CARA Welfare Philippines. It requests information about the owner and pet including name, address, contact details, pet description and whether the pet is pregnant or has had vitamins. It also includes waivers acknowledging the risks of surgery and anesthesia/sedation and waiving liability for CARA Welfare in the event of injury or death. Signatures are required to consent to the procedures and waivers.

    Original Description:

    CARA Spay Neuter Application Form

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a spay and neuter application form for CARA Welfare Philippines. It requests information about the owner and pet including name, address, contact details, pet description and whether the pet is pregnant or has had vitamins. It also includes waivers acknowledging the risks of surgery and anesthesia/sedation and waiving liability for CARA Welfare in the event of injury or death. Signatures are required to consent to the procedures and waivers.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    26 views2 pages

    CARA Spay Neuter Application Form

    Uploaded by

    Amanake
    This document is a spay and neuter application form for CARA Welfare Philippines. It requests information about the owner and pet including name, address, contact details, pet description and whether the pet is pregnant or has had vitamins. It also includes waivers acknowledging the risks of surgery and anesthesia/sedation and waiving liability for CARA Welfare in the event of injury or death. Signatures are required to consent to the procedures and waivers.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    Spay and Neuter Application Form

    Owner’s Name _____________________________________ Date ________________________


    Address _______________________________________________________________________________
    Landline ___________ Mobile ___________________ Email _____________________________________

    PET’S NAME CAT/DOG? GENDER AGE DESCRIPTION PREGNANT? VITAMINS? *NOTCH?


    (M/F) (Y/N) (+100 Php)
    (color/markings) (Y/N)

    *Any cat that is allowed to go and stay outside should have its ear notched
    Can the animal be handled safely? ____________________________

    ------------------------------------------------------------------------------------------------------------------

    I, __________________________________________, of legal age, do hereby declare that I am aware of the risks involved in
    surgical procedures for cats and dogs. CARA Welfare’s veterinarians and staff will exercise due diligence and
    care during surgical procedures of the animals under its charge; however, I understand that despite such care
    and diligence, surgical procedures are not without risk and that animals undergoing such procedures
    sometimes suffer unforeseen injuries and even death. Thus, having attested to the foregoing, I declare that I
    will not hold either CARA Welfare Philippines or the attending veterinarian(s) responsible in any way in the
    event that my pet(s) should suffer any injury or death as a result of the surgical procedures. CARA is not
    responsible for a pet’s injury or death that happens after surgery. The animal must be fully awake before
    leaving the clinic and each animal should be placed in separate containers/cages. I also state that the animal
    has not had food or water for 9 hours pre-operative.
    I am signing this waiver of my own free will and that I have been given written post operation care
    instructions.

    Signature __________________ Printed name ____________________________Date _____________

    SEE BACK PAGE

    REFUSAL TO PERFORM BLOOD TEST BEFORE SURGERY WAIVER

    I, __________________________, refuse to conduct a blood test for my cat/s and/or


    dog/s prior to the scheduled surgery date. I understand that there are risks involved during and after the
    surgery. I waive any claims of damage against CARA Clinic, in the event of injury or death of my pet/s.

    I have read the foregoing and agree.

    CONTACT NUMBERS 175 Lopez Rizal St., cor. Samat St., EMAIL ADDRESSES
    +639-02-532-3340 Brgy. Highway Hills, Mandaluyong [email protected]
    +639-10-729-7026 City, Metro Manila, Philippines, 1552 [email protected]
    Signature ______________ Printed Name ______________________________ Date _______________

    -------------------------------------------------------------------------------------------------------

    SEDATIVE AND ANESTHESIA WAIVER

    I, __________________________, hereby give permission to CARA Clinic to anesthetize and/or


    sedate my cat/s and/or dog/s. I understand all anaesthesia/ sedative used in the surgery involve risks to
    my pet/s, but CARA Clinic will not be held liable or responsible in any manner whatever or under any
    circumstances in connection therewith, as it is thoroughly understood that I have assume all risks. I waive
    any claims of damage against CARA Clinic, in the event of injury or death of my pet/s.

    I have read the foregoing and agree.

    Signature ______________ Printed Name ______________________________ Date _______________

    CONTACT NUMBERS 175 Lopez Rizal St., cor. Samat St., EMAIL ADDRESSES
    +639-02-532-3340 Brgy. Highway Hills, Mandaluyong [email protected]
    +639-10-729-7026 City, Metro Manila, Philippines, 1552 [email protected]

    You might also like