Microchip Form

Your pet will be implanted with a microchip and will be enrolled in the HomeAgain® Pet Recovery Service. For that reason, we share your contact information with HomeAgain®,which provides pet recovery and wellness services. Your contact information will be retained and used by Home Again solely for the purpose of delivering the services and products under the HomeAgain® Program, please visit www.homeagain.com for more information.

Consent

I authorize and direct the The City of Great Falls Animal Shelter or its contractors to implant a microchip in my pet. In exchange for my participation in the County’s microchip program,I hereby agree to hold harmless and release the City of Great Falls, including its employees,contractors, subcontractors, volunteers, elected and appointed officers, and agents, from any and all liability, loss, or damages for any and all demands, costs, judgments, or claims past, present, and future of any nature whatsoever, arising out of or in connection with implantation of the microchip, including, but not limited to, any adverse effects on my pet’s health. I further expressly waive any and all claims or rights to any compensation or damages arising from the microchip implantation. Given the nature of this program, I understand that this waiver and release is necessary for the City to offer this program to the general public at nominal expense. In granting my consent and the above release I hereby state that:

1. I understand that the microchip is not a tracking device or a GPS transmitting device. Animals with microchips cannot be tracked or monitored from a remote location.
2. I understand that it is my responsibility to keep my contact information updated with the microchip registry company, and that if I do not keep my contact information updated it will drastically decrease the likelihood of my pet being reunited to me.
3. I understand that the insertion procedure is medical in nature and accept that there is an inherent risk of harm to my pet involved in the insertion procedure, and that my pet could potentially be injured during the procedure. Furthermore, I accept that my pet may develop side effects after microchip insertion and that I must examine the site of injection over the next week. I understand that if my pet develops any unanticipated problem following insertion of the microchip, it is solely my responsibility to seek veterinary care as needed or directed. I acknowledge and agree to accept all short and long term risks to my pet of the microchip insertion and personally accept any and all responsibility for the care of my pet in connection with the procedure, including any necessary veterinary care and the costs thereof. I further acknowledge and agree that the City of Great Falls Animal Shelter and its contractors (paid or unpaid) shall bear no legal or financial responsibility for liability, including but not limited to, any charges I may incur for veterinary services.

By typing my name in the Signature line: I certify that I have read and consent to the above information, and all information entered on this form is true and accurate.