Spay and Neuter Clinic

Spay or Neuter Interest Form

Please fill out this form and a SparKy representative will contact you.
Your Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number (where you can be reached the day of surgery)*

Area CodePhone Number
County*
Animal Name*
Type of animal*

CatDog
Sex*

MaleFemale
Age of animal*
Please indicate weeks, months, or years
Color of Animal*
Breed (If for a dog, choose other and type breed)*

Cat - DSH (Domestic Short Hair)Cat - DLH (Domestic Long Hair)Other
Do you have a regular vet who cares for your animals?*

YesNo
This animal is...*

a peta strayferal
Feral cats will receive ear tips.

Cost

Female Cats - $55

Male Cats - $45

Female Dogs -

Male Dogs -

Rabies Vaccine - $10

FVRCP (Feline Viral Rhinotracheitis, Calicivirus, Panleukopenia) Vaccine - $10

Canine Distemper/Parvo vaccine - $10

Canine bordetella (kennel cough) vaccine - $10

Microchip - $15
IT IS IMPORTANT FOR YOU TO UNDERSTAND that the risk or injury and death, although extremely low, is always present just as it is for humans who undergo surgery. Carefully read and understand the following before signing your name:

I, acting as the owner/agent of the pet named above, hereby request and authorize Saving Paws Animal Rescue of KY, through whomever veterinarians they may designate, perform an operation for sterilization of the animal named on the above portion of this form. I do understand that the operation presents some hazards and that injury or death of such an animal may conceivably result. I understand the inherent risk of failing to maintain current vaccinations and waive all claims arising out of or connect with the performance of this operation due to such failure. I understand that some factors significantly increase surgical risk, including but not limited to, pregnancy, heat, and diseases. I understand that if my animal is pregnant, the pregnancy will be terminated during surgery.

I understand if my pet has unexpected complication arise during surgery there may be an additional charge.

I hereby release Saving Paws Animal Rescue of KY, all veterinarians, assistants, volunteers, directors, and employees from any and all claims arising out of, or connected with, the performance of this procedure or any adverse reactions from vaccinations. I, acting as owner/agent hereby agree to indemnify and hold Saving Paws Animal Rescue of KY harmless for any damages, deaths, or accidents caused by transportation of my pet for and damages caused by any unforeseeable events.
Signature*

Clear
By signing my name above, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
Today's Date

MonthDayYear
Date
After receiving this form, a SparKy representative will contact you via email with infomation regarding payment and important surgery details. Please check your email, including your spam folder, as this is how we will communicate with you.

If you miss your appointment, payment is nonrefundable.
Should be Empty:

Spay or Neuter Interest Form