Release of Liability and Permission to Perform Vaccinations & Limited Medical Services.
The undersigned states that he or she is the owner of the animal(s) to be vaccinated. The owner agrees that or Dr. Roger McMillan and the Northeast Arkansas Humane Society, hereafter referred to as the NEAHS, are providing a service to the undersigned by providing a low-cost vaccination program. In return for this service, the undersigned agrees to hold harmless. Dr. Roger McMillan, and the NEAHS, and employees from any and all claims related to the procedure(s) performed to the animal(s) belonging to the undersigned. The undersigned also agrees, if asked to comply with the income qualifications by providing proof of government assistance or income in the form of two recent (within the last 30 days) and consecutive pay stubs. (See income guidelines) The undersigned acknowledges that the vaccines and tests may be administered by a vet tech and that we are not a full-service vet clinic, so further treatments may be needed at owner's vet at the expense of the owner.
*Payment Disclaimer: Full payment on the day of registration. I also understand if I am a no show or do not cancel 24 hours prior to my appointment I will lose my payment and unable to reschedule.*