I hereby certify I am the owner or authorized agent of the owner, of the animal, and I give Belmont Veterinary Center full authority to perform a surgical spay/neuter, or other surgical procedures on said animal. I hereby release Belmont Veterinary Center from any and all liability arising from said surgery, adverse reactions, or unforeseeable events. I understand and accept, although rare, there are inherent risks, including death, involved with any anesthetic and surgical procedure.
**Full payment is due at the time of drop-off**