PETPROMISE CITY KITTY PROGRAM AGREEMENT

Todays date*

Date

Name*

First NameLast Name

Email address*

Phone*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please describe the cat(s) you wish to have spayed/neutered (age, gender, number, tame or feral): Please include details of how long you've been caring for them and in what capacity (food, shelter, vet care, etc)*

Are you willing to continue to feed and monitor the cats as long as you live at your current address? Please explain where they will be fed and what shelter is available to them.*

Are you able to transport the cats to and from a designated veterinarians office? *

Are you willing to keep the cats confined in a trap on your property in a garage on a porch or deck or other safe area for up to 48 hours both before and after the surgery? Please explain where they will be kept.*

Please provide the address and location of the property on which the cats described above are living the colony location.*

I understand that the cat(s) will be returned to the colony location after surgery.*

I Do.

I understand that the cats will be returned to the colony location after surgery*

I understand that I will be required to contribute $5/per cat to receive services as part of the PetPromise City Kitty Program BEFORE an appointment will be made for the cat(s)*

I certify that: I own the property identified above as the colony location and give permission for the cats listed above to live out their lives on this property as an outdoor cat. (If not owned by me, I have secured the property owner's/manager's permission for the cats listed above to live out their lives on this property as an outdoor cat.)*

I Do.

I certify that I did not purchase or adopt the above identified cats, obtain them from a shelter or another person, nor have I relocated the cats from another location. The are "unowned" cats living outdoors and under my daily care.*

I Do.

I certify that I have made every attempt to educate my neighbors about the benefits of the trap/neuter/return program for population management, especially those who have expressed concerns about the cats, and notified neighbors of my intention to trap cats so they can contain any of their cats that may be allowed outdoors during the trapping period.*

I Do.

I agree to feed or arrange for the feeding of the cat or the cat colony regularly throughout the year, including weekends, holidays, and during my vacations or absence from the area.*

I Do.

I will arrange for a responsible successor caretaker in the event that I or the original caretaker moves away or is no longer capable of fulfilling his or her caretaker responsibilities.*

I Will.

I will make every attempt to remove sick or injured cats from the colony for immediate veterinary care or humane euthanasia, if deemed necessary.*

I Will.

I will use the program solely to benefit these cats and I will not commit any unlawful act.*

I Will

I will indemnify and hold harmless PetPromise, its Board of Directors, and Volunteers from any liability based on my participation in the PetPromise City Kitty Program, and release them from any claims of past, present, or future liability.*

I Will

In exchange for my participation in the PetPromise City Kitty Program, I understand and agree as follows:

1. To waive and release PetPromise, and any participating veterinary hospital or clinic, its employees, agents, and others from any claims of any liability that may arise from the procedure on any cat(s) that I have brought in to the PetPromsie City Kitty Program;*

I Do.

2. That I understand that I will not be entitled to request the euthanasia of any cat brought into the program. and that all euthanasia decisions will be made jointly by the veterinary staff and PetPromise Board members.*

I Do.

3. I understand that PetPromise may determine, at any time and in its sole discretion, that a cat brought in to a participating veterinarian as part of the City Kitty Program is adoptable and take it into the PetPromise Dog/Cat Rescue Program for adoption;*

I Do.

4. To release and hold harmelss PetPromise, its volunteers, and the participating veterinary facilities from any liability for complications, injury, escape, or death of a cat brought into the PetPromise City Kitty Program*

I Do.

5. I understand that the attending veterinarian, in consultation with PetPromise, shall be entitled to humanely euthanize any cat found to be severely ill or injured such that it would make it inhumane for that cat to continue to suffer due to its illness or injury.*

I Do.

I certify that I have carefully read this release and fully understand it. I am aware that this is a release of liability and a contract between the undersigned and PetPromise and its veterinary partners. And the typing of my name below is evidence of my intent to be bound by this agreement.*

I Do.

Name*

First NameLast Name

PetPromise . Life for pets. Pets for Life. www.petpromise.org . 614-738-2149