As with any surgery requiring anesthesia, certain risks may result in serious complications or even death. By signing this agreement, I understand and am aware of the risks whenever surgery is performed. I First Name Last Name , hearby give my permission to ACSpay and their partners in this program to perform anesthesia and surgery on my pet. In addition to the surgery, I understand that a rabies shot will be administered to my pet in compliance with State or Federal Laws.I also agree to, assert no claim, charge or demand of any kind on the staff, veterinarians, or personnel affiliated with the ACSpay program and assume responsibility for follow up care of required from spay/neuter surgery.I fully and completely release the Corinth Alcorn Animal Shelter harmless from any claim, cause of action, demand of any sort or nature as a result of the ACSpay surgical program. I understand that this program is dedicated to spay/neuter procedures and rabies vaccination and that no other procedures are included. IF you wish preventative shots or worming to be provided, it can be administered for a cost of:DogsDAPP L4 $12 Wormer (Strongid) $4Heartworm Test $15 Skin Test $12Bravecto Flea & Tic (3 mon) $25 Nails Trimmed $15CatsFellocell 4 $15 Wormer (Strongid) $4FIV/FL Test $17 Frontline Flea and tic $8Signature of Owner ________________________________________________________Print Name _________________________________________________________________Address ____________________________________________________________________Phone ______________________________________________________________________