Microchip Clinic Registration Form

Microchip Clinic Registration Form

Thank you for your interest in the microchip clinic brought to you by Find Toby in PA, York Technical Institute (YTI), Leadership York and generously funded by donation to Find Toby in PA from Penn State Harrisburg Ice Hockey Team.
Important Information

Pre-registration enables us to capture information for you and your pet so we can administer and register the microchip as quickly as possible and appointment times will be prioritized over walk-ins. Each pet requires a separate registration per microchip.

Microchipping is limited to dogs & cats only.

Pets cannot be microchipped without proof of current (not expired) rabies vaccination at the time of the microchip clinic April 18, 2026. The actual certificate of rabies vaccination form with veterinarian signature and description matching the pet is required at the clinic. Rabies Tags will not be accepted.

All dogs must be on regular leash 6ft or shorter, NO RETRACTABLE LEASHES; All cats must be in a pet carrier.

We reserve the right to refuse micrcochipping any pet if they are unable to be safely handled for the microchipping process.
Full Name of Pet Owner*

First NameLast Name
Name of Pet*
DogCat
Breed of Pet*
Pet Color/Markings*
Pet Date of Birth, if unsure, select Jan 1 of the applicable year.

For example, if your pet is 6 years old, select Jan 1, 2020.
Date of Birth of Pet:*

MonthDayYear
Date
Male, Not NeuteredMale, NeuteredFemale, Not SpayedFemale, Spayed
Pets cannot be microchipped without proof of current (not expired) rabies vaccination at the time of the microchip clinic April 18, 2026.

The actual certificate of rabies vaccination form with veterinarian signature and description matching the pet is required at the clinic.

Rabies Tags will not be accepted.
Date of Rabies Vaccine EXPIRATION dated April 18, 2026 or after: *

MonthDayYear
Date
Owner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Please select an appointment time below.

Each pet requires a separate appointment time.

Appointments will be seen before walk-ins.

Arrivals more than 15 minutes after your selected appointment time will be treated as walk-ins.
Appointment*
By selecting "I Understand." below, I acknowledge and understand that:
- Microchipping may be refused if my pet is unable to be safely handled
- Appointment times are estimates and may not reflect the exact time your pet is seen.
- Your form submission successfully confirms your appointment - we recommend adding Smart4Paws@yahoo.com to your email contacts. We will not be responsible for missed emails.
- Microchipping is limited to dogs & cats only.
- Pets cannot be microchipped without proof of current (not expired) rabies vaccination at the time of the microchip clinic April 18, 2026.
- The actual certificate of rabies vaccination form with veterinarian signature and description matching the pet is required at the clinic. Rabies Tags will not be accepted.
- All dogs must be on regular leash 6ft or shorter, NO RETRACTABLE LEASHES; All cats must be in a pet carrier.
- Microchip clinic will be held rain or shine on Saturday April 18, 2026 from 10am - 2pm.
- Appointment spots will be held for 15 minutes from scheduled time. Arrivals more than 15 minutes past your appointment time will be handled as walk-in based on availability.
I Understand.
Should be Empty: