SPCA of Brevard Microchip Application and Consent Form

Please fill out the form below and our Lifesaving Coordinator will contact you to schedule your microchip appointment at our adoption center.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

1st Pet Information

Please write their name, species (dog, cat), age, breed, and color.

Male

Female

Spayed/Neutered

Yes

2nd Pet Information

Please write their name, species (dog, cat), age, breed, and color.

Male

Female

Spayed/Neutered

Yes

If you have more than 2 pets needing microchips, how many animals are in need of micochips?

I hereby authorize and direct the SPCA of Brevard to implant a microchip in my pet listed above. I fully release the SPCA of Brevard, its employees, and its agents from any legal and financial responsibilities, claims, demands, damages, or actions arising from microchipping. Furthermore, I accept that my pet may develop side effects after microchip insertion and that I must examine the site of the injection over the next week. I understand that if my pet develops any unanticipated problem follow insertion of the microchip, it is solely my responsibility to seek veterinary care as needed or directed, including any necessary veterinary care and the costs incurred thereof. I understand that the microchip is not a tracking device or a GPS transmitting device. Animals with microchips cannot be tracked or monitored from a remote location. I understand that it is my responsibility to keep my contact information updated with the microchip registry company, and that if I do not keep my contact information updated, it will drastically decrease the likelihood of my pet being reunited to me.

Date

YYYY

SPCA of Brevard Microchip Application and Consent Form

Location

Mailing Address

Hours

Contact