I, the undersigned, do hereby certify that I am the owner (or authorized agent of the owner) of the above described animal, and to the best of my knowledge as the owner- my pet(s) is/are healthy and has no recent signs of sickness such as sneezing, coughing, vomiting, diarrhea, nor nasal or ocular discharge. Appetite and activity level is normal. I acknowledge the benefits of vaccinations for my pet(s) and authorize the above selections I have chose, at this time. I am aware that my pet(s) will only be examined for the appropriateness of vaccines selected. This is not a full and complete physical examination by the veterinarian. I understand adverse vaccine reactions, although rare may occur and in that event I as the owner will be responsible for any medical or emergency care necessary.