Medical Waiver

Medical Waiver

Lucky Cat Rescue and Sanctuary
Greetings!

We appreciate your willingness to adopt one of our animals who has a medical condition. This form is to ensure that we have explained the risks and possible issue associated with this condition.

Please do understand that adopting this animal is purely voluntary and Lucky Cat Rescue And Sanctuary agrees to pay only for the Treatment(s) as indicated prior.
Participant's Responsibility
I acknowledge that I have been given full disclosure regarding the cats/dogs medical issue and their ongoing medical needs. I take full responsibility for any and all ongoing medical needs and care the dog/cat may require.

I understand that Lucky Cat Rescue and Sanctuary is not a medical provider and makes no representations or warranties, express or implied, regarding any medical care or treatment provided. By his/her signature below, Adopter/Owner understands the dignosis and that any recurrence will not be covered at the expense of Lucky Cat Rescue and Sanctuary.
Medical Issue(s)*
example: Skin Condition/infection, URI, Irritable Bowel, congenital defect/deformity
Animal Name*
Breed*
Sex of Animal*
Age of Animal*
Name of Owner/Adopter*

First NameLast Name
Owner / Adopter Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Adopter/Owner Email*
Upload the front image of your drivers license or government issued ID*

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Upload the back image of your drivers license or government issued ID*

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Signature*

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Medical Waiver

Participant's Responsibility