Spay/Neuter Contract & Appointment Form

Spay/Neuter Contract & Appointment Form

Complete this form to schedule your pet's spay/neuter procedure with Mitchell County Animal Rescue.
Owner / Appointment Information
Please note that animal pick up will be available the following day between 9:30 AM and 10:00 AM.
Spay/Neuter Date
Please note that staff will not be available until 6:30 AM. We appreciate your patience and apologize for any inconvenience this may cause. Please be advised that all animals must be checked in by 6:30 AM. Additionally, please complete a separate form for each animal being scheduled for a procedure.
Owner Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact
Pet Information
Pet’s Name
Breed
Age
Sex
Color(s)
Vaccination / Medical Status
Is your pet's Rabies vaccine current?
Is your pet's Distemper vaccine current?
Does your pet have a microchip?
Instructions & Acknowledgment
Pre-Surgery Instructions:
- Pets five months and older may have a quarter of their usual breakfast the morning of surgery; animals four months or younger may have half of their usual breakfast.
- All pets can have water up until the time of surgery.
- Drop-off is at the shelter between 7:30 am the day of surgery unless otherwise instructed. Pick-up is the following day between 10:30–11:00 am.
- You will be contacted by the vet’s office only if an issue arises.
- If you miss an appointment without calling ahead, your pet will be moved to the back of the list for surgeries. If you miss two appointments without calling ahead, your pet will be removed from the list.

Acknowledgment: I acknowledge that I am the owner of the above animal. I understand that all fees must be paid before appointments will be made. I understand that if my pet is not picked up at the specified time, I will be charged a $20.00 boarding fee. I will not hold Mitchell County Animal Rescue, their staff or board members responsible for any illness or injury my pet may accrue while being transported or while having surgery.
I have read and understand the above contract and am at least 18 years of age.
Signature Section
Pick up will be the next day at 9:30-10:00 AM
Owner Signature
Witness Signature
Signature Date

MonthDayYear
Date
My Products
prevnext( X )
Spay/Neuter
$80.00 Quantity

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty:

Spay/Neuter Contract & Appointment Form

Owner / Appointment Information

Pet Information

Vaccination / Medical Status

Instructions & Acknowledgment

Signature Section

My Products

Payment Methods