I am the owner or legally authorized custodian of the animal described above and I am at least eighteen (18) years old. *

I consent to and authorize SOUTHPAW RESECUE and Dr. Lisa MacDonald, associate veterinarians, registered veterinarian technicians and assstants to vaccinate my pet. *

I understand that SOUTHPAW RESCUE has the right to refuse service to any animal if the health or behavior of the animal is of concern. *

I acknowledge that such vaccinations do not constitute complete health care. It is essential that my pet receive a yearly physical examination. *

To the best of my knowledge, my pet is healthy, is NOT pregnant, has no known allergies to vaccines or medications and has not been experiencing any lethargy, vomiting, diarrhea, sneezing, runny eyes or nose, coughing, or other signs of disease or illness. *

I understand that vaccination may cause unexpected reactions in pets. If my pet has an adverse reaction, I understand that the clinic does have emergency medications on hand. However, I am responsible for seeking immediate medical treatment as well through a veterinary hospital and not SOUTHPAW RESCUE. *

I agree to accept all risks of vaccinations and to personally accept both legal and financial responsibility for all charges incurred due to such risks. *

I agree to indemnify, hold harmless and release SOUTHPAW RESCUE, the attending veterinarian, veterinary technicians, and assistants, and any of the officers, employees, board members, volunteers, or agents of SOUTHPAW RESCUE, including Petco Love Foundation, Bissel Foundation, and all other donors from all liability that might arise in connection with the services provided to the above-named animal. *

I understand that the veterinary services provided today do not include any future visit(s) that may require additional vaccines to be administered, products, treatments, or services rendered. *

All photographs and/or video taken of myself and/or my pet may be used by SOUTHPAW RESCUE in support of their charitable purposes and at their sole discretion. I waive the right to all compensation for use of these images. *

My signature below indicates that any questions I have regarding my pet's medical procedures have been answered to my satisfaction. *

I certify that all information written on this form is true and accurate. *