5.1.22 Low-Cost Microchip Clinic

Josephine County Low-Cost Microchip Clinic

Brought to you by the Josephine County Animal Shelter and Shelter Friends
WHAT: $15 microchips for dogs, CASH ONLY

WHEN: Sunday, May 1st

WHERE: North Middle School (1725 NW Highland Ave, Grants Pass)

WHEN: Appointment times vary 10am-12pm; register below for an appointment time.

WHO: Josephine County residents

Services will only be provided to those who are registered in advance. No walk-ins.

Fill out this form entirely to register your dog(s).

This event is for DOGS only. We are only offering miocrochips at this event. Stay tuned for more services at future events.
This information will be used to register your pet's microchip

Please double check your entries for errors.
Owner Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Backup Phone Number

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email:
example@example.com
Pet Name: *
Pet's Date of Birth: *
If unknown, please make your best guess.
Primary Breed(s) *
If unknown, please choose what they most look like.
Primary Color(s) *
Sex of pet: *

Male Female
Is your pet fixed? (i.e., spayed or neutered) *

Yes No
Pet Size (best guess): *

Under 20lbs 20-50lbs Over 50lbs
Do you have an additional dog you'd like to bring? (Please note there is a limit of 2 dogs per household.) *

Yes No
Pet #2 Name: *
Pet #2 Date of Birth: *
If unknown, please make your best guess.
Pet #2 Primary Breed(s) *
If unknown, please choose what they most look like.
Pet #2 Primary Color(s) *
Sex of Pet #2: *

Male Female
Is Pet #2 fixed? (i.e., spayed or neutered) *

Yes No
Pet #2 Size (best guess): *

Under 20lbs 20-50lbs Over 50lbs
Clinic Procedures & Arrival Instructions

-Please follow current COVID recommendations
-You must remain in your vehicle until direction is given
-Dogs Only for this event (no cats)
-No Children outside of vehicles
-Dogs must be on leash, even if being held
-Please arrive only during your allotted time
-The people working the event are volunteers. Please treat them with respect.
-CASH ONLY

Failure to follow procedures or direction from our volunteers will result in us not being able to provide you service.
*

I have read and agree to the above rules.
PLEASE READ AND CONSENT TO THE FOLLOWING TERMS BY SIGNING BELOW:

I am the owner of the animal(s) presented for this clinic, and I have the authority to give this consent for these procedures. I understand that the Veterinarians and certified vet technicians will perform the procedures to the best of their ability, always taking into account the safety of the animals first.

I agree to inform anyone handling my animal(s) of any known risks of biting, snapping or any other risk that could cause harm.

To the best of my knowledge, my animals have no allergies to vaccines. I will inform the Veterinarian and staff of any current medical conditions or medications that may increase my animals’ chance for adverse reactions to vaccinations. I understand that vaccine reactions are possible, though they are rare.

If my animals become ill due to vaccines or the procedures completed, I will not hold Josephine County, Shelter Friends, the Veterinarian or certified vet technicians responsible. I hereby waive and release Josephine County, its officers, agents, employees, and volunteers from any and all claims or losses which may arise from the procedure. I agree to treat any reactions at my own Veterinarian or emergency clinic at my own cost.

I understand that this is not a complete exam for the overall health of my animals, and that my animals should be examined yearly by my own Veterinarian.

My animals have had not recently had any illnesses such as coughing, sneezing, vomiting, diarrhea, runny eyes, runny nose, or fever. I certify that my animals are in good health. I understand that the clinic has the right to refuse to provide services if it will cause harm to my animals.

I understand there are no refunds or exchanges for any of the services provided at this clinic.

I understand all dog owners are required by law to have a current dog license from the Josephine County Public Health Department.
Draw your signature if you read and agree to the terms above. *

Clear

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Josephine County Low-Cost Microchip Clinic

This information will be used to register your pet's microchip