Clinic Application BIG BERTA"S SPAy Day

What is her name?

What is HER date of birth or estimated age?

What breed and color is she

How much does she weigh?

Where does she live?

How many other pets do you currently own? Please list all and their species..

To the best of my knowledge, my animal is healthy.

I understand if my pet becomes ill or I have a concern, I will seek medical attention from my own personal veterinarian.

I understand this clinic is only for female dogs that are 60 pounds or larger.

Please tell us which services you are interested in.

Do you live in the City of Lockhart?

If you live in the City of Lockhart do you have a mandatory city tag for your dog? If not we will provide one free of charge.

I am at least 18 years of age and legally able to book an appointment and have the authority to execute this consent.

To the best of my knowledge the animal I am booking an appointment for is in good health. I acknowledge the fact that all care of my animal is my responsibility as I am the owner and/or responsible party of the animal.

I understand if ANY problems occur, or I have questions I am to contact my own personal Veterinarian at my own expense.

I agree to indemnify and hold harmless Caldwell County Animal Coalition (CCAC), the property owner, the attending veterinarian, The City of Lockhart, Caldwell County and their affiliates, from and against any and all liability arising out of the performance of any procedures/vaccines performed on my animal.

I acknowledge this a low-cost clinic. My pet is NOT receiving an in-depth physical examination; I am taking full responsibility that my animal is healthy. I will be responsible for any additional medical expenses that may occur after this clinic or as a result of this clinic. I release the veterinarian, Caldwell County Animal Coalition, Caldwell County, The City of Lockhart, and the property owner from any and all responsibility that may arise as a result from this clinic.

NO SHOWS WILL NOT REFUNDED AND FUNDS RENDERED WILL BE CONSIDERED A DONATION UNLESS ARRANGEMENTS HAVE BEEN MADE PRIOR WITH CCAC. I UNDERSTAND THERE ARE NO REFUNDS.

I have read, understand, and agree to the terms and conditions stated in this document. I consent to the TREATMENT AUTHORIZATION & RELEASE all as stated above.

I THE PET OWNER OR AGENT THEREOF, CONFIRM AND AGREE THAT ALL INFORMATION I HAVE PROVIDED ON THIS FORM IS ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE. I FURTHER AGREE TO THE TERMS ABOVE.

I understand I will receive a contract/invoice for payment and that until I render payment I DO NOT have a confirmed appointment contract is paid and returned. If all spots are filled I will put on a wait list.

Would you be interested in volunteering in any capacity for CCAC?

Do you consent to photographs of our event that may have your animal in them.

Please type your name and today’s date.