Spay and Neuter Application – Tucson Action Team

Please fill out the form in its entirety. All asterisked questions MUST be answered. By submitting this application, All statements are true to the best of your knowledge. A member of the team will contact you to schedule an appointment. All appointments are subject to a nonrefundable $55 fee that includes spay/neuter surgery, cone and pain medications.

* – indicates a required field.

Name

First

Last

Address, City, Zip Code

Please add your zip code to your address.

Phone

Dog's Name

Dogs Age

Years

Months

Dog Breed

Dogs Sex

Male
Female

Dogs Weight

Shots Current

In the last three weeks, has your dog been exposed to Parvovirus or Distemper?

Could your dog be pregnant? (females only)

Any Medical Conditions? (if none, type none)

last Shots you

How did you hear about us?

Additional information We Should Know

Liability Statement

Check Here to Acknowledge

By acknowledging above and submitting this form, I affirm that all statements provided are true and accurate. I understand and agree that participation in any programs or activities organized by Tucson Action Team is voluntary and undertaken at my own risk. Tucson Action Team, including its officers, directors, employees, volunteers, and affiliates, shall not be held liable for any injury, loss, damage, or claim arising from my participation, whether caused by negligence or otherwise. I hereby release and hold harmless Tucson Action Team from any and all liabilities, claims, or demands of any kind, known or unknown.

I further grant permission for Tucson Action Team to photograph or record me (or my pet) during program activities and to use such images or recordings for promotional, educational, or organizational purposes, in print or digital form, without compensation. I waive any right to review or approve the final materials.