PAL Application

"*" indicates required fields

Your Name*

First Last

Address*

Street Address Address Line 2 City Province Postal Code

Phone Number*

How many pets do you currently own (dogs/cats/other)?*

Are your other pets spayed/neutered?*

Yes

What is the name of the pet that you are applying for?*

What type of animal is he/she?*

Dog

Cat

What Breed?*

Age?*

Does the pet you are applying for have any medical/behavioral concerns (if yes, please specify)?*

How many puppies/kittens is your pet currently caring for?*

Age of litter?*

Is your pet currently pregnant?*

Yes

Name of Your Veterinarian/Vet Clinic?*

What is the date of your pet’s last visit with the veterinarian?*

Is your pet up to date on yearly vaccines?*

Yes

Do you require any other assistance to help care for this litter? (food, dishes, blankets, newspaper, etc) If yes, please specify.*

Please read the following Waiver of Responsibility:

The Victoria County SPCA or the Florenceville Veterinary Clinic shall not be held responsible for any injury (including death) to my animal while participating in the PAL Program. I hereby release and waive any right of action against the Victoria County SPCA, the Florenceville Veterinary Clinic, their heirs, assigns, servants, agents, employees, or Board of Directors for any such loss or injury (including death). The Victoria County SPCA or the Florenceville Veterinary Clinic is not responsible for any additional costs associated with the spay surgery. I understand that failure to surrender the entire litter of kittens/puppies that my cat/dog has had could result in termination of my participation in the PAL Program. I hereby certify that the information I have provided is true and correct and that I have not omitted anything which would make my application false or misleading.