AFEW Cat Spay/Neuter Clinic Application

Animal Friends for Education and Welfare (AFEW) Cat Spay/Neuter Clinic Application

This application will generate an email to an A.F.E.W. representative, who will respond via email within 5 business days with further instructions.

Owner's Name (if rescue group, fill in rescue group name)
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone - (###) - ### ####
Work Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Email *
This cat is: Owned With a Rescue Group Feral
Sex of Cat Male Female Unknown
Cat's Name (If feral, please use "Feral #1, Feral #2...)
Cat's Breed Domestic Short Hair Domestic Medium Hair Domestic Long Hair Purebred
If the cat is purebred, please indicate which breed:
Cat's Colors
Cat's Age under 6 months 6 months - 1 year 1 - 2 years 3 - 4 years over 5 years
Would you like for your cat to receive a rabies vaccination? ($10.00 additional charge) Yes No
Would you like for your cat to receive a distemper vaccination? ($10.00 additional charge) Yes No
Would you like for the cat's ear to be notched (ferals only)? ($2.00 additional charge) Yes No
Would you like your cat to be tested for AIDS and leukemia? ($25.00 additional charge) Yes No
1) I certify that I am the owner or the agent for the owner of the animal described above and I have authority to execute this consent. Yes No
2) I have read "Important Information", "After Care Instructions" and "In Case of an Emergency" and understand tht there are certain risks and complications associated with any operation or procedure of this tyme. I understand that the clinic will not provide, pay nor reimburse my expenses for any postoperative veterinary care. Yes No
3) I understand that I may not bring the cat in a cardboard carrier, soft-sided sherpa bag or wire dog crate. The cat must be in a plastic hard-sided cat carrier (only ONE cat per carrier) to allow for visibility during recovery after surgery, for the cat's safety and for the veterinary staff to be able to handle the cat. If bringing feral cats in traps, I will bring a carrier for each cat to be put in after surgery. Yes No
Please list any additional questions you might have and note any health conditions your pet has that we should be aware of:
If your pet is not getting a rabies shot at the clinic, please bring proof of rabies vaccination to the clinic.
Signed (type name)
Date / MM / DD YYYY
IMPORTANT: Before hitting the "submit" button, please be sure everything you have entered is correct as we are unable to make changes the day of the clinic. If you are completing this form for somebody else, CHECK WITH THEM FIRST to be sure everything is correct! If you are unsure about vaccinations, DOUBLE CHECK FIRST please!

AFEW Cat Spay/Neuter Clinic Application

AFEW Cat Spay/Neuter Clinic Application

If your pet is not getting a rabies shot at the clinic, please bring proof of rabies vaccination to the clinic.