Don & Sug Wells Spay Event Registration Form
Only a limited amount of appointments are available and will be scheduled by the admins. 
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Name of Animal Owner *
Phone Number *
Email *
Name of Pet (Please fill out a form for each pet) *
Only Farmerville and Natchitoches remain
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Species *
Required
Sex *
Required
Breed *
Color *
Age (approx.) *
Weight (approx.) *
Is your pet current on their rabies and yearly vaccinations?  *
Required
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. *
Required
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. *
Required
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. *
Required
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 *
Required
I agree to drop off my animal(s) no later than 8 a.m. on the day of the procedure(s), and retrieve my animal(s) at 2:30 p.m. the same day as the procedure(s). Animals not picked up the day of surgery may be considered abandoned and subject to citation. *
Required
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. *
Required
 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. *
Required
I understand that the Co-Pay of $60 per animal is due BEFORE procedure via PayPal or through the DONATE button on our website.
  Please indicate how you will be paying.  
 *
Required
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