Eligibility, Authorization and Waiver
By submitting this form, I certify that I am the Owner/Authorized Agent of the pet/s listed. I authorize The Humane Society of Washington County and all participating veterinarians, employees, and volunteers to receive, handle, examine, sedate, anesthetize and perform surgery on the pets/s.
I agree to indemnify, hold harmless and release of all liability The Humane Society of Washington County and all participating veterinarians, employees, volunteers, and any of their personal representatives, heirs, successors and assigns, from and against all action claims, damages, disabilities, or expenses, including attorney's fees and witness costs that may be asserted by any person or entity, including me arising out of or in connection with the care, treatment, surgery, or safe keeping of the pets/s. Further, I understand that it is not possible for you to guarantee that any medical or surgical procedure will be successful and without complication, including, but not limited to, the death of my pets/s. I understand these risks and assume all responsibility for such complications and will not hold The Humane Society of Washington County and any participating veterinarians, employee or volunteer responsible.
I certify that I have read and understand the above paragraphs. I understand that this is an application to participate in this program and that The Humane Society of Washington County has the right to deny or refuse any application.
By filling out and submitting this spay/neuter application, you certify that the information given is true and complete. You understand that any false information will be cause to terminate all actions on this process. You also authorize the release/disclosure of records and other information of the foregoing inquiries and veterinary records.