Drive-Thru Rabies Vaccine Clinic Logo
  • Drive-Thru Rabies Vaccine Clinic

    5635 Harris Hill Rd, Suite 6, Williamsville NY 14221
  • December 13th, 2025

    9am-12pm

    The information submitted below will be used on the rabies certificate. Filling out this form confirms your attendance. 

    This is a drive thru vaccination clinic, People & pets will stay in vehicles. Animal handlers will transport pets from vehicle to veterinarian for vaccination.
    All dogs must be on a leash; small dogs may be in carriers.

    **ONE FORM PER DOG**

  • Consent Release

    I, the undersigned owner (or authorized agent) of the above animal, understand and agree to the following:
  •    1    Voluntary Participation
    I am voluntarily bringing my pet to participate in a Free Rabies Vaccine Clinic hosted by Nickel City Canine Rescue (NCCR). I understand that this clinic is a community service event, and participation is completely voluntary. 

        2    Limited Service Provided
    I understand that this clinic is for the rabies vaccination only, and that no other medical services, diagnoses, or treatments will be performed. No full physical exam is included. I have disclosed any known health issues, prior vaccine reactions, or behavioral concerns to the clinic staff.

        3    Risk Acknowledgment
    I acknowledge that there are inherent risks in handling animals and in receiving vaccinations, including but not limited to allergic reactions, stress, injury, or illness. I voluntarily assume all risks for myself, my pet, and any accompanying persons.

        4    Release of Liability
    In consideration of the free vaccination service provided, I hereby release, waive, and hold harmless Nickel City Canine Rescue, its volunteers, veterinarians, staff, sponsors, property owners, and all affiliated parties from any and all claims, damages, injuries, or expenses arising from or related to participation in this clinic or the administration of the vaccine.

        5    Owner Responsibility
    I certify that I am the legal owner (or authorized caretaker) of the animal listed above. I agree to keep my pet safely restrained by leash or in a secure carrier at all times. I am responsible for any injury or damage my pet may cause to any person, animal, or property. 

        6    Aftercare Responsibility
    I understand that if my pet experiences an adverse reaction or requires additional care following vaccination, I am responsible for obtaining and paying for any necessary veterinary care.

        7    Consent for Treatment
    I authorize the attending veterinarian or designated personnel to administer a rabies vaccine to the animal listed above.

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