I have read and agree to all of the following:

1. I certify that I am 18+ years old and that I am the legal owner or duly authorized agent for the owner of the pet described above. I hereby give permission for my pet to be vaccinated at West Valley Humane Society by either the veterinarian on duty, or the veterinary technician on duty.

2. I understand that payment is due in full before services will be rendered by WVHS. I further understand that all payments are final. Refunds will not be issued for any reason by WVHS.

3. I understand that if the vaccine series lapses by more than 4 weeks, the series will have to be restarted and I will not receive a refund. I understand that I will have to pay for a new series of vaccines to restart.

4. I understand that if I do not schedule an appointment within 3 weeks of form submission, I will be required to fill out a new form.

5. I am aware that WVHS does not vaccinate sick, diseased or pregnant animals. I have disclosed such information. I have also made WVHS aware of any previous vaccine reactions my pet may have had, including any allergies. I acknowledge that such vaccinations do not constitute complete healthcare.

6. I understand that vaccinations may cause unexpected reactions in pets, including death. I understand that there will be no guarantees as to the results, effectiveness or accuracy of any vaccination.

7. I understand that if my pet at any time becomes too aggressive for WVHS staff to safely handle, I will be asked to restrain my animal with a muzzle. I release WVHS of all liability and understand than I may be assessed additional fees up to $25.

8. I agree to accept all risk of vaccinations and personally accept both legal and financial responsibility for all charges incurred. I understand that WVHS will not assist with emergency care and I am financially responsible for any other veterinary visits.

9. I understand the vaccine clinic is an opportunity for WVHS to provide reduced cost vaccines. It is not a setting for comprehensive exams, consultations, diagnosis, treatment, medical concerns or other behavioral problems. I understand these need to be addressed by my family veterinarian.