I, the undersigned, hereby request Street Cat HUB to facilitate surgical spay/neuter.

I agree that each cat and kitten spayed/neutered, or deemed previously spayed/neutered, will have one ear tipped to ease recognition upon re-release unless other arrangements are explicitly made. I agree to pick up the cat(s) following surgery as directed. I understand that if I fail to pick up the cat(s) as requested by Street Cat HUB, the cat may be declared abandoned and will be handled as such.

I declare under penalty of perjury that if I have any reason to believe these cat(s) are owned that I am properly authorized to present the cat(s) for the indicated surgery and treatments and/or release all authority and agency to Street Cat HUB to determine whether the cat(s) are legally unowned and therefore eligible for surgery & treatments. If I am not the registered owner of these cat(s), I release the authority to determine the best/rightful outcome for the cat(s) to Street Cat HUB. I understand that Street Cat HUB will scan the cat(s) for a microchip. If a microchip is found, Street Cat HUB will not perform further procedures unless the chip is unregistered or given permission immediately by the chip registrant.

I recognize and understand the risks inherent to anesthesia and surgery, particularly for cat(s) that are pregnant, in heat, injured, sick, and/or have no medical history available. I understand that the cat(s) may not undergo a complete pre-anesthetic evaluation by a veterinarian. I accept the risks for any underlying health problem that would complicate recovery and/or survival from anesthesia and/or surgery. I consent for the veterinarian to use their discretion if Street Cat HUB cannot promptly reach the caretaker.

I understand that any cat(s) presented as an “ear-tip cat” for free surgery is assumed unowned/free-roaming. If the cat(s) experiences an adverse reaction to anesthesia and/or surgery, is deemed by our veterinarian to be seriously ill and/or injured, or is unlikely to humanely survive if released to a free-roaming lifestyle, every reasonable attempt to contact the listed caretaker will be made before humanely euthanizing the cat. I permit euthanasia in advance for any and all “ear-tip” cat(s) that I present to Street Cat HUB, today or in the future, for free spay/neuter. By signing this Surgical Release Form, I give my authorization for euthanasia in this circumstance.

I declare that I have been feeding the cat(s) or have direct knowledge that the cat(s) are being fed regularly. I promise to see that all cats receive food, water, and necessary care regularly when returned after surgery to the location from which you collected them or to an alternate location if prohibited from returning to their original site. I acknowledge that once released, some cats may not return. I agree to provide this cat with any and all follow-up care that the cat(s) may need after surgery.

I grant Street Cat HUB, its representatives, and employees the right to take photographs and/or videos of my cats while at the clinic for surgery. I agree that Street Cat HUB may use such photographs and/or video of the cat(s) with or without my name and for any lawful purpose, including such purposes as publicity, illustration, advertising, and Web content.

I agree to hold Street Cat HUB harmless should any cat(s) die before, during, or after surgery or experience complications not resulting in death. I agree to hold harmless and indemnify Street Cat HUB, its agents, officers, employees and/or volunteers, and any organization(s) with whom Street Cat HUB may partner and their associates from any losses, injuries, and damages to myself and/or to the cat(s) arising out of, or in any way connected to, the services requested or provided herein. This includes trapping, transport, treatment, sedation, vaccinations, surgery, recovery, the cat(s)’ release, etc.

To the best of my knowledge, I certify that this cat I am presenting to Street Cat HUB has not bitten anyone in the preceding ten days.

OWNED CATS ONLY

I agree to provide this cat with any and all follow-up care that may be needed after surgery. This may include, but is not limited to, seeking veterinary care for any postoperative complications related to or unrelated to spay/neuter surgery, as well as treatment and/or follow-up for any administered treatments and/or pre-existing conditions.