Spay and Neuter Assistance 2022

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Spay And Neuter Assistance Form For All Locations

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Name of Animal Owner *

Phone Number *

Which City Are You Closest To? *

Pineville, LA

Winnfield, LA

Natchitoches, LA

Name of Pet (Please fill out a form for each pet) *

Species *

Cat

Dog

Obbligatorio

Breed *

Age (approx.) *

Weight (approx.) *

Is your pet current on their rabies and yearly vaccinations? If no, please explain in next box. *

Yes

Obbligatorio

If you answered "no" to above question, please select all vaccinations your pet currently does NOT have. *

Yearly Vaccinations

Rabies

Not applicable/ I answered Yes to the above question

Obbligatorio

Who is your current veterinarian? If you have none, please answer "none." *

Please read the following statements and click I agree if you agree. Please note that if you click "I disagree," you may not be considered for our assistance program.

I understand that spay/neuter surgery carries a risk of complications including death(s) to the animal(s). I hear by assume full responsibility and agree to waive any and all claims against The Heart of Louisiana Humane Society. *

I agree.

I disagree.

Obbligatorio

I understand the animals may be groggy when released and should be kept in a safe, enclosed area 24 hours after the procedure. I will make every attempt to observe the animal for post-surgical complications including, but not limited to, incision infection and lack of appetite. In case of post-surgical problems, I agree to arrange the appropriate veterinary care at a full service facility at my own expense. *

I agree.

I disagree.

Obbligatorio

To the fullest extent permissible under applicable law, I agree to hold harmless, indemnify, and release The Heart of Louisiana Humane Society their agents, officers, veterinarians, volunteers, representatives, and employees, from any and all loss, injury, liability, damage, or cost I may incur or suffer due directly or indirectly from the spay/neuter surgery and removal and housing of this animal whether caused by HLHS the veterinary clinic of the procedure. *

I agree.

I disagree.

Obbligatorio

I agree not to disparage or denigrate the Heart of Louisiana Humane Society orally or in writings digital and physical, and that neither I nor anyone acting on my behalf will publish, post, or otherwise release any material in written or electronic format, make speeches, gain interviews, or make public statements that mentioned the companies/organizations, its operations, clients, employees, products, or services without the prior written consent of the companies/organizations *

I agree.

I disagree.

Obbligatorio

I WILL NOT PROVIDE FOOD/WATER AFTER MIDNIGHT THE DAY BEFORE MY PROCEDURE TO MY ANIMAL(S) AS THIS INCREASES THE RISK TO MY ANIMAL(S) EXPONENTIALLY. *

I agree.

I disagree.

Obbligatorio

I have read and understand the release statements and waiver of liability and indemnity agreement and I agree to be legally bound by all terms as permitted by applicable law. I also authorize that I, as legal owner of the above listed animal, am the true authorizer of these statements. *

I agree.

I disagree.

Obbligatorio

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