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November 20, 2003ASPCA Mobile Spay/Neuter Clinics
I, _____________________________, working on behalf of _______________________________________, acknowledge, agree, and understand that I must comply with the requirements below when I utilize the services of the ASPCA Mobile Spay/Neuter Clinics (the “Mobile Clinic”). Further, I understand that in the event that I fail to adhere to any of the terms outlined below, the Mobile Clinic will no longer accept animals from me or my organization for spay/neuter or any other Mobile Clinic services. II. Qualifications
a) All animals needing spay/neuter services must meet the following criteria: 1) They are homeless animals only (including feral cats and “junkyard dogs,” animals that have
been recently adopted out by my organization, or animals that will be put up for adoption).
None of the animals are owned pets (unless permission is obtained from the Mobile Clinic
management staff prior to using the clinic).
g) For Feral Cats Only: I understand that the Neighborhood Cats workshop “Trap-Neuter-Return: How to
Manage a Feral Cat Colony” is a mandatory prerequisite to use of the ASPCA Mobile Clinic for all TNR groups and individuals. For your and your cats’ safety, all TNR appointment-makers must be confirmed TNR certified. Your name will be cross-referenced, by ASPCA staff, with the TNR Certification list. If your name is not found on the certification list, the NYC Feral Cat Initiative will be contacted to assist in confirmation. If ASPCA staff are not able to confirm that you have been TNR certified, you will not be permitted to make a rescue appointment. h) When Attending Your Appointment Day: The appointment maker must be the person to drop off
animals on the day of spay/neuter. Picture ID must be presented at intake. If someone other than the
appointment maker attempts to drop off animals, those animals will not be admitted for spay/neuter
surgery. The appointment maker may not send someone on his or her behalf to drop off animals at
i) When Picking Up Your Animals: The appointment maker may send an individual on his or her behalf
for animal pick up. Appointment makers must notify schedulers of this situation, and provide the name of the person authorized to pick up the animal(s), when they make their appointments. The person designated to pick up your animal(s) will also have to show picture ID at the clinic. The appointment maker must be available by phone during discharge. This will allow Mobile Clinic staff to review the terms of the general discharge information and also any special situations, such as if a particular animal requires special care. j) Aftercare Protocol: Your animal(s) will be discharged with a sheet of take-home instructions. If you
notice anything out of the ordinary as your animals recover, please call (877) SPAY-NYC, which is available 24 hours a day, 7 days a week, to triage the issue over the phone. ASPCA staff answering the phone will advise you on home care and, if necessary, will arrange a recheck. • Post-operative rechecks will be accommodated, whenever possible, on a Mobile Clinic (the Mobile Clinic to which you are referred may not be in the same vehicle, nor in the same location, as your initial Mobile Clinic visit). • If, in the opinion of the ASPCA staff on (877) SPAY-NYC, follow-up urgent care is needed during business hours (8:00 a.m. to 7:00 p.m., Monday through Friday, and 9:00 a.m. to 5:00 p.m. on Saturdays), you must bring the animal to Bergh Memorial Animal Hospital (BMAH) for treatment (424 East 92nd Street). • If, in the opinion of the ASPCA staff on (877) SPAY-NYC, follow-up urgent care is needed outside BMAH hours, you must bring the animal to an alternate emergency clinic, as determined by ASPCA staff. Absent extraordinary circumstances, if an animal experiences post-operative complications requiring follow-up
care as a direct result of spay/neuter surgery, the ASPCA will either cover costs directly, or reimburse you for
out-of-pocket costs you incur to provide that care, up to a maximum of $1,500. Transportation costs to and
from any follow-up care facility, including the Mobile Clinic, are always the responsibility of the rescuer
and will not be covered by the ASPCA. Expenses over $1,500 will not be reimbursed unless the rescuer has
sought, and received, advance written authorization from the Call Center at (877) SPAY-NYC to incur the
III. Services to be Rendered
I understand that all animals brought to the Clinic will be spayed/neutered and vaccinated against rabies and
all feral cats will be eartipped unless they already have private placement. These services are provided at no
cost, although donations are greatly appreciated. Other services will be offered, by request only, and only in
conjunction with the spay/neuter surgery, and at the costs in section IV.
If I elect to have any procedure in addition to spaying/neuter and a rabies vaccination performed on an animal, I will indicate those services by labeling the animal’s carrier accordingly. Any animal in a carrier without a label will be spayed/neutered, rabies vaccinated and, if a feral cat, eartipped. The ASPCA rents humane traps for TNR purposes only to people who have taken the Neighborhood Cats
workshop. If I choose to borrow traps from the ASPCA trap bank, I will do so in understanding and agreeing to
the following: Traps must be picked up and returned Monday through Friday from 11:00 a.m. to 5:00 p.m. at
ASPCA headquarters (424 East 92nd Street) by confirmed appointment only. No walk-ins permitted! Traps
may be kept for up to 10 days. A fully refundable deposit of $50 per trap is required, payable by cash or by
check. Appointments to pick up or return traps can be made by calling (877) SPAY-NYC.
I understand that the ASPCA Mobile Spay/Neuter Clinics do not provide services beyond those listed below. I understand that I, or my designee, must pick up all animals from the Mobile Clinic, on the same day as the surgery/vaccination, at the time designated by the clinic staff and in accordance with Section II(i), above. I understand that all payment for services rendered is due at pickup. IV. Pricing for Supplemental Mobile Clinic Services*
MYSELF AND THE ORGANIZATION THAT I WORK OR VOLUNTEER FOR, (B) AM OVER EIGHTEEN (18)
YEARS OF AGE, (C) HAVE READ THE ABOVE AGREEMENT CAREFULLY PRIOR TO ITS EXECUTION
AND FULLY UNDERSTAND ITS CONTENTS AND REALIZE THAT THIS IS AN ENFORCEABLE LEGAL
DOCUMENT BETWEEN MYSELF AND THE ASPCA, AND (D) SIGN OF MY OWN FREE WILL.
ACKNOWLEDGED AND AGREED TO BY:
Name: __________________________________________________________________________________ Signature: ____________________________________________________ Organization (if applicable): _________________________________________________________________ Address: ________________________________________________________________________________ City: ________________________________________ E-mail: ______________________________________________ NOTE: MEDICATION WILL ONLY BE DISPENSED TO YOU WITH THE EXPLICIT AUTHORIZATION OF
THE ASPCA AND SOLELY IN CONNECTION WITH ANIMALS ACTUALLY BEING TREATED IN THE
Please send completed, signed document:
MSNC Client Services
1717 South Philo Road, Suite 36
Urbana, IL 61802
OR by e-mail:
OR by fax: (217) 337-9810
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