Canine Surgery Consent Form - Animal Medical Center of Wyoming

PHONE NUMBER WHERE YOU CAN BE REACHED TODAY: *

Owner *

Pet Name *

Rabies Expires *

I, City of Gillette Animal Shelter, being responsible for the above described animal, have the authority to grant you my consent to perform the selected procedures upon my pet. You are to use all responsible precautions against injury, escape, or death of my pet, but you will not be responsible or liable in any manner in connection therewith as it is thoroughly understood that I assume all risks. I will be responsible for all fees and service charges including legal fees associated with the treatment of my pet. *

I have read and understand

Signature *

Clear Signature

Date *