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Beautiful Hearts Animal Rescue
  • Current Rescues
  • Adoption Form
  • Events & Clinics
    • Senior Pet Care Program
  • About
    • FAQ
  • Donations
  • Circle of Support
  • Senior Pet Care Program
  • Contact

Beautiful Hearts Rescue Vaccine Clinic

April 21, 2024

PLEASE READ AND CONSENT TO THE FOLLOWING:

  • I am the owner or authorized agent of the animal(s) listed and consent to have the above services performed.
  • My animal(s) is/are not pregnant and do not have a chronic medical condition.
  • My pet is currently healthy and has not shown signs of illness (coughing, sneezing, vomiting, diarrhea, lethargy, loss of appetite, fever, etc.) within the past 14 days.
  • My pet has no history of having an adverse reaction to vaccinations.
  • I agree to hold Beautiful Hearts Rescue and Horse Sanctuary, Ltd., its employees and affiliates free and harmless from any and all illness and/or injuries sustained and/or loss incurred by pet owners or pets during, prior to, or after the vaccine clinic. Should my animal(s) become ill due to vaccines, I agree to treat any medical concerns/conditions or vaccine reactions at my own veterinarian or emergency clinic, and this will be my financial responsibility. I am aware such reactions are possible, though they are rare.
  • I understand that this is not a full and complete exam. A comprehensive exam should be performed at least yearly at my local veterinarian.
  • I understand that records will be emailed to me after the event. If I do not receive the email I can contact Beautiful Hearts Rescue and ask for duplicate copies to be sent by sending an email to beautifulheartsanimalrescue@gmail.com
Date(Required)

Please Fill Out Completely

Address(Required)
Did you attend last year’s clinic?(Required)
Please, choose the amount of animals that will be registered

Animal 1

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 2

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 3

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 4

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 5

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 6

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 7

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 8

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 9

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 10

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 11

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?

Animal 12

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 13

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 14

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Animal 15

Animal(Required)
Sex(Required)
MM slash DD slash YYYY
Spayed/Neutered
Based on your records did this pet attend last year’s clinic?(Required)

VACCINES REQUESTED

Rabies:(Required)
Verified 3 year eligible(OFFICE USE ONLY)
Animal specific core vaccines:(Required)
Would you like us to Microchip your pet today for FREE?(Required)

Do you want any extra services today?(Required)

Extra services have a fee and may require boosters to be effective.

We can process credit cards

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Please let us know if any of the below apply.

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