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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

* GenderMaleFemale

Country

*State/Province

Date of Birth

* Month

* Day

* Year

About Your Cat

This form is used to gather the information to have your cat spay/neutered. Polk County Humane Society will be transporting cats to the Sedalia Spay & Neuter Clinic for spay/neuter services and vaccinations (optional) once a month. We plan to announce the dates a few weeks in advance.

Please complete one form per cat that you'd like to send with us. Note: Sedalia Spay & Neuter Clinic will NOT spay/neuter cats over 7 years of age and the cats must be at least 12 weeks old and 3 lbs.

Cat's Name

Cat's Size

Your best estimate of the current size of your animal.

Small Cat (less than 5 lbs)Medium Cat (5-8 lbs)Large Cat (8-11 lbs)Extra Large Cat (over 11 lbs)

Cat's Breed

Your best guess of your animal's breed

Domestic ShorthairDomestic Medium HairDomestic Long HairSiameseMaine CoonOther

Cat's Age

Your best guess of the age of this animal.

3 months old4-6 months old6-8 months old8-11 months old1 year old2 years old3 years old4 years old5 years oldOver 5 years old

Cat's Gender

MaleFemaleUnknown

Primary Color of Cat

Black`WhiteBrown TabbyGrey TabbyTortoiseshell Calico or Dilute CalicoTuxedoGray/BlueOtherOrange/YellowOrange/Yellow Tabby

Is this cat feral (wild)?

Yes (I CANNOT pick up this cat and will be trapping it)No (I CAN pick up this cat and put it in a carrier)Not sure (I'm not sure yet if I can pick up this cat or will have to trap it)

Is this cat anxious or does it have the potential to bite a person?

Yes (This cat might bite someone, be careful.)No (This cat is tame and won't bite anyone.)Not sure (I'm not sure if this cat will bite or not.)

Is this cat already current on it's rabies vaccine?

Yes, this animal is current on its rabies vaccine.No, this animal is NOT current on its rabies vaccine.I dont' know if this animal is current on its rabies vaccine or not

Services Requested

Cat Spay or Neuter - $60Basic/Combo Vaccination (FVRCP) - $20Rabies Vaccination - $15Ear Tip (feral cats only) - $0 (This is cutting off the tip of one ear to indicate that a feral cat is neutered or spayed)

Consent

I authorize the surgery and other services I have selected for this animal. I understand there are risks involved and hold the Sedalia Spay & Neuter Clinic and Polk County Humane Society harmless from liability for any adverse outcomes.

Yes

Signature

Please type your name below as your signature on this form:

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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Cat Neuter/Spay Sign Up Form

Personal Information

About Your Cat

Consent