Don't Breed a Bully Spay/Neuter Form

Don't Breed a Bully Spay/Neuter

The Animal Shelter of Sullivan County Don't Breed a Bully Project

Owner's First Name *
Owner's Last Name *
Please upload a photo of your Drivers License or Government ID. *
Owner's Address including City, State, Zip * Must live in Sullivan County to be eligible
Owner's Phone Number *
Owner's Email
Breed of Dog *
Please upload a picture of your pet you are needing help getting spayed/neutered. *
Pet's Name *
Pet's Age or DOB *
Male or Female *
Pet's Color *
Does your animal have a current rabies vaccination? *
Please attach proof of current rabies vaccine if answered yes to above question. We must have proof of current rabies or the animal will receive a rabies vaccination.
The Animal Shelter of Sullivan County (ASoSC) Spay/Neuter Clinic uses qualified staffing and approved materials for all procedures performed. It is important that you understand that the risk of injury or death, although extremely low, is always present, just as it is for humans who undergo surgery. Carefully read and ensure you understand the following before signing your name. *
I, acting as owner or agent of the pet named above, hereby request and authorize the Animal Shelter of Sullivan County Spay/Neuter Clinic, through whomever veterinarians they may designate, to perform an operation for sexual sterilization of the animal named on the above portion of this form. *
I understand that the operation I have elected presents some hazards, and the injury to, or death of, an animal may conceivably result, for there is some risk in procedure, and some risk in the use of anesthetics and drugs provided for the procedure. *
I either certify that my animal has been vaccinated one year prior to this date, or waive my right to protect my animal by having it vaccinated, or request recommended vaccines at the time of surgery. I understand that it takes up to two weeks for vaccinations to protect my animal. *
I understand the inherent risks of failing to maintain current vaccinations and waive all claims arising out of, or connected with, the performance of this operation due to such failure. I understand that if my dog develops kennel cough after surgery I am responsible for treatment at my own cost. *
I certify that my animal is in good health and has had no food since 12:00 midnight the evening prior to surgery. *
I understand that the Animal Shelter of Sullivan County has the right to refuse to any animal to whom surgery is deemed a health risk. *
I understand that The Animal Shelter of Sullivan County may not perform a complete physical exam before surgery is performed. I also understand that my animal will not receive any pre-operative blood work, and waive my right to have this performed prior to surgery at a full-service veterinarian. *
I understand that some factors significantly increase surgical risks, including, but not limited to pregnancy, heat and diseases such has feline immunodeficiency virus (FIV), feline leukemia (FeLV), and heartworms. *
I understand that if my animal is pregnant, the pregnancy will be terminated at the time of surgery and there is an additional fee of $15. *
I understand that if my animal has an open umbilical hernia, it will be repaired at the time for an additional $15. *
I understand that if I do not retrieve my pet at the agreed-upon time, The Animal Shelter of Sullivan County will exercise its right to intake the animal at the shelter as an abandoned animal. Owners of pets left after the agreed date shall be charged a boarding fee of no less than $10 per night. *
I hereby release the Animal Shelter of Sullivan County, all veterinarians, technicians, assistants, volunteers, directors, and employees from any and all claims arising out of, or connected to, the performance of this procedure or any adverse reaction to vaccinations. I agree that I have not and will not claim any right of compensation from them, or file action by reason of such sterilization or attempted sterilization of such animal or any consequences related thereto. Owner/agent hereby agrees to indemnify and hold ASOSC harmless for any damages caused by the transportation of animal, for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters, or acts of God. *
Your animal will receive a small permanent tattoo on his/her underside to show that he/she has been sterilized. *
I hereby release The Animal Shelter of Sullivan County from any and all claims arising out of or connected to, the performance of this procedure or any adverse reaction to vaccinations. I agree that I have not and will not claim any right of compensation from them, or file action by reason of such sterilization or attempted sterilization of such animal or any consequences related thereto. Owner/agent hereby agrees to hold ASOSC harmless for any damages caused by transportation or animal, and for any damages caused by unforeseeable events. *

Together we can do great things for the animals of Sullivan County