form center

2. Due to the large number of kittens we are currently caring for, out-of-county appointments are temporarily suspended.
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Can we text this phone number?*
    -- Select One --YesNo

    Select one

16. Email Address*
18. How many total dogs will you need assistance with?
    -- Select One --123
20. Dog Name
21. Dog Age (Estimate)*
22. Color
23. Secondary Color
25. Gender*
    -- Select One --MaleFemale
26. Weight*
27. Breed*
31. Dog Name
32. Dog Age (Estimate)
33. Color
34. Secondary Color
36. Gender
    -- Select One --MaleFemale
37. Weight
38. Breed
42. Dog Name
43. Dog Age (Estimate)
44. Color
45. Secondary Color
47. Gender
    -- Select One --MaleFemale
48. Weight
49. Breed
51. How did you get your dog(s)

    1. Appeared / Found on my property or neighborhood
    2. Given to me by a friend / family member

    1. Online / Social Media (eg. Facebook Marketplace, Craigslist)
    2. Other

    (Check all that apply)
53. On the day of surgery your dog will receive a spay or neuter surgery. You may elect to also purchase the following (check all that apply):

    1. Microchip $15
    2. DAPPV $15
    3. Heartworm Test $20
    4. Rabies Shot $10 (required if proof of current rabies is not provided)
55. How many total persons live in your household?*
57. Have any of your animals that need spayed or neutered ever shown aggression (towards dogs or people) in a vet setting?*
    -- Select One --YesNo
59. If yes, please explain:
61. Total Household Income*
63. If no household income, please explain:
65. 1. I understand that through the income-based spay-neuter program my dog(s) will receive spay or neuter, and rabies shot if I am unable to provide current proof.*
    Initial
67. 2. I understand that the spay / neuter surgery carries a risk of complications, including death, to the animal(s). I hearby assume full responsibility and agree to waive any and all claims against Williamson County Government and Williamson County Animal Center ("WCAC") and their agents, officers, veterinarians, contractors, volunteers and employees in the event of escape, sickness, injury, complications or death of my animal(s) related to the spay / neuter surgery.*
    Initial
69. 3. I understand that animals may be groggy when released, and should be kept in an enclosed area for 24 hours after the procedure. I will make every attempt to observe the dog for post-surgical complications including, but not limited to, incision infection and lack of appetite. In case of post-surgical problems, I agree to arrange the appropriate veterinary care at a full service facility at my own expense.*

    Initial

71. 4. I agree to retrieve my dog(s) the same day as surgery. Dog(s) not picked up the day of surgery may be considered abandoned and subject to citation.*

    Initial

73. 5. To the fullest extent permissible under applicable law, I agree to hold harmless, indemify, and release Williamson County Government, and WCAC, their agents, officers, veterinarians, contractors, volunteers, and employees, from any and all loss, injury, liability, damage, or cost I may incur or suffer due directly or indirectly from the spay / neuter surgery and removal and housing of this animal whether caused by Williamson County Government or WCAC, their officers, agents, veterinarians, volunteers or employees. *
75. 6. I VOLUNTARILY SIGN THIS RELEASE AND WAIVER OF LIABILITY, and further agree that no oral representations, statements or inducements, apart from this written agreement have been made. I further attest that the above listed dog is my pet or in my custody of care, and that I have the authority as the owner or agenty to authorize the removal and housing by WCAC.*
77. I HAVE READ AND UNDERSTAND THE ABOVE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT AND I AGREE TO BE LEGALLY BOUND BY ALL TERMS AS PERMITTED BY APPLICABLE LAW.*
    Signature of Owner or Agent:
78. Date*

80. *Please be sure to check your spam/junk folder if you do not receive a response to your application within 2-3 business days.*

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82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit

* indicates a required field