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2. First Name*
3. Last Name*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Email Address*
14. Can we text this phone number?*
    -- Select One --YesNo
16. How many total cats will you need assistance with?*

18. Appointments are made only for a cat that is identified on this application.  Cats that are not identified will not be accepted at time of appointment.

22. Cat's Name:
24. Cat #1: Age (estimate)
25. Color
    -- Select One --BlackWhiteSilverBrownCalicoOrangeTuxedoTanTortie
26. Secondary Color
27. Hair Length
    -- Select One --Short HairLong HairHairless
29. Gender

    1. Male

    1. Female

    1. Unknown
30. Are you able to handle this cat?
    -- Select One --Yes, I can pet this cat.Yes, I can pet and pick up this cat.Neither
31. Where does this cat live?
    -- Select One --Indoor onlyOutdoor onlyBoth

    Choose one
35. Cat #2: Name
36. Cat's Age (Estimate)
37. Color
38. Secondary Color
40. Hair Length
    -- Select One --ShortMediumLongHairless
41. Gender
    -- Select One --MaleFemaleUnknown
42. Are you able to handle this cat?
    -- Select One --Yes, I can pet this catYes, I can pet and pick up this catNeither
43. Where does this cat live?
    -- Select One --Indoor onlyOutdoor onlyBoth Indoor / Outdoor

    Choose one
47. Cat #3: Name
48. Cat's Age (Estimate)
49. Color
50. Secondary Color
52. Hair Length
    -- Select One --ShortMediumLongHairless
53. Gender
    -- Select One --MaleFemaleUnknown
54. Are you able to handle this cat?
    -- Select One --Yes, I can pet this catYes, I can pet and pick up this catNeither
55. Where does this cat live?
    -- Select One --Indoors onlyOutdoors onlyBoth indoor / outdoor
59. Cat #4: Name
60. Cat's Age (Estimate)
61. Color
62. Secondary Color
64. Hair Length
    -- Select One --ShortMediumLongHairless
65. Gender
    -- Select One --MaleFemaleUnknown
66. Are you able to handle this cat?
    -- Select One --Yes, I can pet this catYes, I can pet and pick up this catNeither
67. Where does this cat live?
    -- Select One --Indoors onlyOutdoors onlyBoth indoor / outdoor
71. Cat #5: Name
72. Cat's Age (Estimate)
73. Color
74. Secondary Color
76. Hair Length
    -- Select One --ShortMediumLongHairless
77. Gender
    -- Select One --MaleFemaleUnknown
78. Are you able to handle this cat?
    -- Select One --Yes, I can pet this catYes, I can pet and pick up this catNeither
79. Where does this cat live?
    -- Select One --Indoor onlyOutdoor onlyBoth indoor / outdoor
83. If more than 5 cats, please describe each cat.
85. If any of your cats are a specific breed, please specify.
87. If any known medical conditions for any of the cats, please explain:
89. Do any of these cats have nursing kittens?

    1. Yes
    2. No
91. Any other information you would like us to know?
93. Example of an ear tip, the universally-recognized sign of a cat who has been spayed or neutered
    

95. Those who qualify may receive free vaccinations for their pet courtesy of Petco Love and the "Vaccinated & Loved" initiative to help end life-threatening pet diseases. 

97. By signing this document and registering for an appointment, you are giving our clinic consent to perform surgery on your pet. Our staff will always answer questions, address concerns and ensure that you have a high-quality experience, but you will not meet or speak with a veterinarian prior to or following the procedure. You will receive detailed medical records.*

    1. Acknowledged
99. 1. I understand that through the Community Cat Program, these cat(s) will receive spay or neuter, microchip, rabies shot and an ear tip to the left ear. (The eartip is a requirement of the Community Cat Program.)*

    Initial

101. 2. I understand that the spay/neuter surgery carries a risk of complications, including death or in the case of spay surgery, potential termination of previously unknown pregnancy, to the animal(s). I hereby 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

103. 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

105. 4. 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. *

     Initial

107. 5. 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 agent to authorize the removal and housing by WCAC.*

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109. 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 OF THIS AGREEMENT AND THAT IT IS INTENDED TO BE AS BROAD AND INCLUSIVE AS PERMITTED BY APPLICABLE LAW.*

     Signature of Owner or Agent:

110. Date:*

112. *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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114. 1. Receive an email copy of this form.
115. Email address

     This field is not part of the form submission.

116. Submit

* indicates a required field