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 cats will you need assistance with? (max. 3 per clinic appointment)
    -- Select One --123
20. Cat Name
21. Cat Age (Estimate)
22. Color
23. Secondary Color
25. Hair Length
    -- Select One --ShortMediumLongHairless
26. Gender
    -- Select One --MaleFemale
27. Where does this cat live?*
    -- Select One --Indoor onlyIndoor and outdoorOutdoor only

    Select one
28. Are you able to handle this cat?
    -- Select One --YesNo
32. Cat Name
33. Cat Age (Estimate)
34. Color
35. Secondary Color
37. Hair Length
    -- Select One --ShortMediumLongHairless
38. Gender
    -- Select One --MaleFemale
39. Where does this cat live?*
    -- Select One --Indoor onlyIndoor and outdoorOutdoor only

    Select one
40. Are you able to handle this cat?
    -- Select One --YesNo
44. Cat Name
45. Cat Age (Estimate)
46. Color
47. Secondary Color
49. Hair Length
    -- Select One --ShortMediumLongHairless
50. Gender
    -- Select One --MaleFemale
51. Where does this cat live?*
    -- Select One --Indoor onlyIndoor and outdoorOutdoor only

    Select one
52. Are you able to handle this cat?
    -- Select One --YesNo
54. How did you get your cat(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)
56. On the day of surgery your cat will receive a spay or neuter surgery. You may elect to also purchase the following:

    1. Microchip $15
    2. FVRCP $15
    3. FeLV/FIV Test $20
    4. Rabies Shot $10 (required if proof of current rabies is not provided)
    5. 3 mo. flea & tick prevention $15
    6. Dewormer (owner administers 2 days after surgery) $15

    (Check all that apply) Payment due the day of appointment. *To participate in this program, cats must be 8 weeks to 10 years of age; 2 lbs or larger and in good health.

58. Total number of persons in the household.*
60. Total Household Income*
62. If no household income, please explain:
64. 1. I understand that through the income-based spay-neuter program my cat(s) will receive spay or neuter, and rabies shot if I am unable to provide current proof.*
    Initial
66. 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
68. 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 cat(s) 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

70. 4. I agree to retrieve my cat(s) between 4pm + 5pm the same day as surgery. Cat(s) not picked up the day of surgery may be considered abandoned and subject to citation.*
    Initial
72. 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. *
74. 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 below listed cat 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.*
76. 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:
77. Date*

79. *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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81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit

* indicates a required field