Service In Form | Ark-Valley Humane Society

Service In Form

Service In Form

**This information is kept confidential**
  • Service In Form

  • Animal Information

  • Date Format: MM slash DD slash YYYY
  • Behavior

  • Medical Information

  • Personal Information

  • Service Agreement

    By signing below, I certify that my animal is current on species-species vaccines. If veterinary documentation of current vaccines is not provided, I agree to allow Ark-Valley Humane Society to give the necessary vaccines as needed under the financial expense of me, the owner. I also authorize to allow Ark-Valley Humane Society to give my animal medication or provide medical treatment as needed or as instructed by me the owner. Medications should be in the original container, indicating the pet's name, medication name, dosage and prescribing veterinarian. I understand that, in the event my animal appears to be ill or significant risk of experiencing a medical problem, Ark-Valley Humane Society will attempt to contact me and/or my emergency contact for instructions prior to seeking veterinary care. If I cannot be reached, I agree that Ark-Valley Humane Society may use its reasonable discretion in seeking veterinary care and I will be responsible for all related expenses. I understand that Ark-Valley Humane Society will not be liable for the actions and decisions of the veterinarian. I understand that there are inherent risks associated with my animal being in a shelter environment and I agree that Ark-Valley Humane Society will not be liable for any claims of injury, illness, damage or death to my animal during its stay and that under no circumstances will Ark-Valley Humane Society be liable for consequential damages. I understand that if my animal is not picked up from Ark-Valley Humane Society within 5 days of the below stated pick up date, without other arrangements made, my animal will be considered abandoned and becomes the legal property of Ark-Valley Humane Society to be outcomed in the manner that Ark-Valley Humane Society determines.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY