By submitting this application, I agree that:
1. I am authorizing, through submission of this form, the Veterinarian named above to release any information and records concerning past or present care of animals to A Second Chance Animal Shelter. I agree to hold harmless and indemnify said Veterinarian for providing such information.
2. I have not, nor has anyone in my household, ever been charged with any form of animal abuse, neglect or cruelty.
3. This animal will be cared for and treated with love and respect. I agree to be fully responsible for it’s well being including the following: