Application For Pet Wellness Clinics

CLINIC REQUESTED:                                 Please Choose Clinic Pet Wellness Dog Pet Wellness Cat Pet Wellness Dog & Cat

DATE OF REQUESTED CLINIC:                 (see clinic description for dates)

LOCATION OF REQUESTED CLINIC:    (see clinic description)

Name:   

Address:

Day Phone:              

Evening Phone:       

Cell Phone:               

Email Address:        

PET #1

Name:       Dog          Cat              Age:

Breed:   Male  Female       Weight:

PET #2

Name:     Dog          Cat                Age:

Breed:    Male  Female        Weight: 

THESE CLINICS ARE OPEN TO ALL HOUSEHOLDS REGARDLESS of INCOME

By submitting this application, I agree to accept a complimentary "Participating Membership" in the Grainger County Humane Society. Participating Members may receive newsletters and information about upcoming events, meetings, and volunteer opportunities; but do not receive voting privileges.

Accept Participating Membership

Please keep my name and pets on file for future pet wellness clinics.

Please keep my name and pets on file for future spay/neuter clinics.

Number of other animals in my care that need spaying or neutering:  Dogs     Cats

You will be notified one week prior to clinic by phone or mail.