First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone

Cell Phone

Cat's Name*

Sex:*
Choose one: Female Male

If you have a female, has she had kittens? If yes, how many litters? How long ago was her last litter?

Color:*

Breed:*
Choose one: Domestic Short Hair Domestic Medium Hair Domestic Long Hair Russian Blue/Mix Siamese/Mix

Age:*

Has your cat received a rabies vaccine in the past 12 months? If so when? And please bring proof on day of visit. *

Has your pet been to a Vet before for anything other than routine vaccines? (Yes / No) If yes when? If yes why? Which vet?

Do you have any concerns that the vet needs to know about? If so what?

Do you want your cat microchipped for an additional $10?*
Choose one: Yes No Maybe

I understand that this operation presents some hazards and that injury to, or death of such an animal may conceivably result, for there is some risk in the procedure and the use of anesthetics and drugs in providing this service. I understand the inherent risk 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 the clinic does not have access to bloodwork and preoperative procedures. I certify that my animal is in good health. Electronic initials imply you understand and agree with terms.*

These services are offered at a much-reduced price through a variety of providers. We currently assist in scheduling and sometimes transporting to low cost spay neuter services to a variety of locations and will disclose that to you when booking the appointment. Pre-existing conditions in my animal(s) may not be known. I agree to place no blame on any of the above providers, Kentucky Kitty Cats, Fots, or any participating Veterinarian or volunteer. I agree that I will not claim any right of compensation from them or file action by reason of such sterilization or attempted sterilization of my animal or any consequences relate hereto. Electronic initials imply you understand and agree with terms.*

All vaccines are kept following standard recommended practices. However, there can be a rare side effect to any vaccine. I hereby release all of the above parties rom any and all claims arising out or connected with adverse reactions to the vaccines. Electronic Initials imply you understand and agree with terms. *

Both females and males will need to be watched carefully for 24 hours after surgery. They will need to be kept up safe from predators and in a dray and warm setting. Females will need their incision area to be checked daily until healed completely. Stitches must be dry for a minimum of 5 days. Anything that looks unusual needs to be addressed. There should not be any pink streaks or discoloration around the incision, and there should not be any fluids or oozing. I will not hold any of the parties listed responsible for problems which may occur AFTER I have brought my animal home, even if such problems require my animal to see a veterinarian and incur a fee while there. Electronic Initials imply you understand and agree with terms.*

Typical cost of female spays is $55. Typical cost of male neuters is $45. These include rabies vaccine unless proof of their current certificate is provided. If pet requires a flea treatment, that is $10. If your cat is pregnant, the pregnancy will be terminated at the time of surgery. If you have a need for financial assistance, please let us know. We do not believe that lack of funding is a reason to allow animals to litter. Electronic Initials imply you understand and agree with terms.*

Kentucky Kitty Cats and its associates reserve the right to refuse to transport or assist in helping obtain procedures on an animal for any reason. Your cat may be tattooed to show proof of alter. Kentucky Kitty Cats and all the above rescues, clinics, and DVMs agree to take care of your animal to the best of our ability while it is in our care. I agree to hold all humans involved in this process harmless for any damages caused by any unforeseeable events including, vehicle accidents (if transported), fire, vandalism, natural disasters, or acts of God. Electronic Initials imply you understand and agree with terms. *

Thank you for choosing to alter your pet, as it is a life saving surgery, not only for your pet, but also for the millions of unwanted animals that are born each year. Please sign below to show that you have read and understood this contract and hereby give permission for sexual stervilation of the animal named above. Electronic Signature implies you understand and agree with terms. *