NEW - Provincial Animal Shelter & Veterinary Clinic - Registered Rescue Spay/Neuter Form Step 1 of 5 20% ORGANIZATIONAL INFORMATIONDate* Organization Name*Organization Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone Number*Fax NumberAre you a CRA Registered Charity?* Yes No Charitable Registration NumberAre you registered with Joint Stocks Nova Scotia?* Yes No Joint Stocks NumberWebsite Email CONTACT INFORMATIONPrimary Contact First Last Title Home Phone*Cell PhoneEmail Secondary Contact First Last Title Home PhoneCell PhoneEmail CLINIC/VETERINARIAN INFORMATIONPrimary Clinic/Veterinarian NamePlease indicate the healthcare your organization provides to rescued/fostered animals (check all that apply)* Veterinary Exam Standard Vaccinations De-Worming Flea Treatment Feleuk Testing FIV Testing Treatment for Skin Conditions Behavioral Screening & Training Rabies Vaccinations ANIMAL INFORMATIONSpecies of AnimalsCatDogAnimal SourcesStraysOwner-SurrendersTNRTransfers from other Organizations PERSONS AUTHORIZED TO PICK-UP ANIMALS ON BEHALF OF ORGANIZATIONName First Last PhoneName First Last PhoneName First Last PhoneTERMS AND CONDITIONS* Yes, I agree to all terms and conditions listed below. 1) The Rescue certifies that all animals submitted to the program will be under the Rescue's ownership and not owned by an individual 2) The Rescue understands that all surgeries must be paid the morning of the surgery, BEFORE the animal is admitted to the Clinic. The Rescue must understand that additional costs may occur during the course of the surgery at the veterinarian's discretion and that the Rescue will be responsible for these costs upon pick up. The Rescue understands that failure to settle these costs will result in suspension of their Rescue Participant Status. 3.)The Rescue agrees to adhere to the set drop-off and pick-up times and understands that failure to pick-up during those times will result in an overnight boarding charge. The Rescue understands that if they fail to pick-up their animal within 72 hours, the animal will become property of the Nova Scotia SPCA Animal Hospital and/or Clinic. They also understand the Nova Scotia SPCA Hospital and/or Clinic will receive/release animals only to Persons listed as authorized by the Rescue. If this information changes, it is the responsibility of the Rescue to update the information with the Nova Scotia SPCA Hospital and/or Clinic. 4.) The Rescue understands that all surgeries are required to be booked through the Hospital/Clinic in advance and that a waiver will be required to be signed upon intake of the animal(s). They also understand that they are required to call to cancel/reschedule the appointment at least 2 BUSINESS DAYS in advance and that a rebooking fee is charged for rescheduling after this time or in the event of no shows. The Rescue understands that repeat no-shows will result in their Rescue Participant Status being revoked. 5.) The Rescue realizes that there can be guarantee as to the animal's condition or the outcome of any medical procedure or treatment. The Rescue must agree with the following: We understand that there are risks associated with any medical procedure or treatment. We have been advised that there is a risk of death whenever an anesthetic/sedative is used in treatment, and approved the use whatever anesthetic the veterinarian deems advisable for the well-being of the animal if an anesthetic is needed. 6.) The Rescue understands and agrees to adhere to the TNR policies set-up by the Nova Scotia SPCA Animal Hospital/Clinic, that include: a) The Rescue must have a place to keep the cat for 1-2 days recovery after surgery b.) Testing services are not provided c.) The Nova Scotia SPCA does not provide live traps d.) The cat must be released in the same place it was trapped in. By clicking YES - I hereby certify that the information provided on behalf of the organization listed above is truthful and correct. I hereby agree to waive any and all claims for damages against the Nova Scotia SPCA Provincial Animal Hospital/Clinic, and any officers, volunteers, or agents of the program in the event of death or injury to the animal during the surgery. I understand that approval of the application of an organization to serve as a rescue participant at the Nova Scotia SPCA Animal Hospital/Clinic Spay/Neuter program is at the sole discretion of the Nova Scotia SPCA and they reserve the right to revoke services.