TNVR Submission Form

I agree to have Berks ARL spay/neuter this/these feral cats and return them to me at which time I will assume responsibility for the cat(s). I understand that Berks ARL will NOT assume responsibility for long-term care or for adoption purposes. 

I understand that the cats I bring in may be humanely euthanized if it is deemed unfit to return to field or if it is determined to be suffering from a life-threatening illness or injury. I understand that there are inherent risks associated with any surgery and all medical decisions are made by the Berks ARL medical team. 

I affirm that I have not taken this animal from another person without that person’s consent.

Berks ARL uses qualified individuals & approved medical grade materials for all procedures performed. It is important for you to understand that the risk of injury or death, although extremely low, is always present, just as it is for humans who undergo surgery. 

Please carefully read, & ensure you understand, all of the information on this agreement before checking the box above.

I, being lawfully authorized to make decisions on behalf of the animal named/described above (the “Animal”), hereby request & authorize “Berks ARL”, including its affiliates & each of their employees, volunteers, veterinarians &/or other agents (collectively, ““Berks ARL” Parties”), as appropriate & in accordance with applicable law, to receive, transport, prescribe for, treat &/or administer rabies vaccinations, if deemed necessary and even if not requested, & any other vaccinations &/or services I have selected below, &/or perform an operation for sexual sterilization of the Animal. 

I understand that it takes up to two (2) weeks for vaccinations to best protect the Animal. By initialing here, I certify that the Animal has been vaccinated within one (1) year prior to this date; or waive my right to protect the Animal by having it vaccinated at least two weeks prior to surgery; or request recommended vaccinations at the time of surgery, as selected above with the knowledge that the Animal will still not be protected. I certify that the Animal has not bitten anyone in the last ten (10) days. 

I understand the inherent risks of failing to maintain current vaccinations and that no vaccination is always 100% protective, & waive all claims arising out of, or connected with, any illnesses contracted post-surgery, including, but not limited to kennel cough or other upper respiratory infections. I am responsible for treatment at my own cost. 

I understand that the operation I have elected presents some hazards, & that injury to, post-operative infection in, or death of, the Animal may conceivably result, for there is some inherent risk in the procedure & in the use of anesthetics & drugs provided for the procedure, as well as in any vaccines used. I understand that general anesthesia will be administered to the Animal for surgery. I understand & accept these risks to the Animal. 

I understand that “Berks ARL”  &/or any “Berks ARL” Party has the right to refuse any service &/or procedure to any animal for any reason, including, but not limited to, situations where surgery is deemed a health risk. Such refusal is at the sole discretion of the attending veterinarian. 

I understand that a pre-surgery exam will not be performed on the animal.  I understand that the Animal will not receive pre-operative bloodwork at “Berks ARL”. If I choose for the Animal to have such bloodwork, I understand that it must be performed at a full-service veterinary clinic.  

 I understand that community cats will be returned to the trap/cage before they are awake to ensure the safety of Berks ARL staff. I understand that community cats might be exposed to infectious diseases including but not limited to: fleas, ringworm, panleukopenia, upper respiratory infections, and FIV/FeLV. I understand that community cats are not weighed prior to surgery so the anesthesia dosage is an estimate which significantly increases risks associated with anesthesia. 

I understand that some factors significantly increase surgical risk, including, but not limited to, pregnancy, heat, & diseases such as feline immunodeficiency virus (“FIV”), feline leukemia virus (“FeLV”), & heartworms. 

I understand that if the Animal is an acceptable surgical &/or vaccination candidate, sterilization procedures &/or vaccinations will be performed regardless of the Animal’s gender &/or medical condition, including but not limited to, pregnancy. I understand if the Animal is pregnant, the pregnancy will be terminated at surgery. 

I understand that I, or someone authorized by me, must pick up the Animal from the location designated by the medical staff, & at the time designated by the medical staff on the day of the surgery &/or vaccination. I understand that, if I do not retrieve the Animal at the designated time, the Animal may be considered by “Berks ARL” to be abandoned by me upon expiration of the statutory hold period. In that event, I understand that, upon expiration of the statutory hold period, “Berks ARL” shall have discretion to deal with the Animal as it deems appropriate.  If I do not pick up the Animal at the designated time and place as described above, I agree to pay a boarding fee of up to $30 per night plus any related costs to medicate or provide for the Animal.  

I understand & agree that the “Berks ARL” & “Berks ARL” Parties  (collectively, the “Released Parties”) shall not be liable to or held responsible by me in any matter whatsoever for, or in connection with, the procedure(s) to be performed on the Animal &/or any vaccinations to be given to the Animal, & I hereby hold the Released Parties harmless from & against any & all liability & damages that may arise. I will take full responsibility, financial & otherwise, if the Animal becomes ill. I hereby agree to indemnify & hold the Released Parties harmless for any damages caused during the transportation of the Animal. The Released Parties shall not be held liable for any damages caused by any unforeseeable events including fire, vandalism, burglary, extreme weather, natural disasters, or acts of God. 

I agree that “Berks ARL” & “Berks ARL” Parties may take, or permit others to take, photographs or video of me &/or my animal, while at “Berks ARL” & that “Berks ARL” & “Berks ARL” Parties may use or authorize the use of the photographs or video of me &/or the Animal in any way it deems appropriate to support the clinic’s mission, including fundraising purposes. 

I understand that if the Animal is infested with fleas, “Berks ARL” may, in its sole discretion, administer a flea product (including but not limited to Capstar®, which effects of treatment last 24 hours), to the Animal. I agree to pay the $10 cost for this treatment when the Animal is picked up from “Berks ARL”. 

FERAL / COMMUNITY CATS BOTH MALE AND FEMALE WILL HAVE THEIR LEFT EAR TIPPED TO SHOW THAT HE/SHE HAS BEEN STERILIZED  

I HEREBY WARRANT THAT I (A) AM AT LEAST EIGHTEEN (18) YEARS OF AGE & THE AGE OF MAJORITY IN THE STATE IN WHICH I RESIDE, (B) HAVE READ THIS AGREEMENT CAREFULLY PRIOR TO ITS EXECUTION, (C) FULLY UNDERSTAND THE CONTENTS OF THIS AGREEMENT, (D) REALIZE THIS AGREEMENT IS AN ENFORCEABLE LEGAL DOCUMENT BETWEEN MYSELF & “Berks ARL”, & (E) VOLUNTARILY SIGN THIS AGREEMENT OF MY OWN FREE WILL. 

BY CHECKING ABOVE, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD, & AGREE TO THE TERMS IN THIS AGREEMENT.