流浪動物絕育手術同意書及損害賠償承擔書
STRAY ANIMAL DESEXING OPERATION CONSENT
AND FORM OF FOREBEARANCE

義工資料 VOLUNTEER INFORMATION

義工姓名Volunteer's Name：

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身份証號碼 ID No.：

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聯絡電話Tel. No.：

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流浪動物資料 STRAY ANIMALS INFORMATION

貓：　   雄性 $______ x ______ 隻     雌性 $______ x ______ 隻
Feline：  Male $______ x ______        Female $______ x ______

犬：　   雄性 $______ x ______ 隻     雌性 $______ x ______ 隻
Canine： Male $______ x ______        Female $______ x ______

原生地點Place of Origin ： _______________________________________

施行之手術：絕育（睪丸／卵巢及子宮切除）
Operation to be performed：De-sexing (Castration / Spay)

 

本人，____________________________________在此同意由伙伴動物公司之獸醫為上述流浪動物施行上述之手術。本人並准許為該動物施行麻醉以及獸醫認為需要之任何其他治療（包括剪耳及外科手術）。本人明白麻醉及外科手術皆可能會有危險，亦瞭解到伙伴動物公司之獸醫會隨時給予專業性之處理，因此現作出不可撤消之承諾，若手術不成功或該動物因手術直接或間接或由於施行麻醉或由於該動物在貴診所接受之任何治療而造成之傷害或死亡或引致任何殘障，本人將不向任何伙伴動物公司之獸醫或有關人仕追究責任。
本人若未能於24小時接回上述流浪動物，本人同意伙伴動物公司可自行處置該動物，包括安排領養或放回原捕捉區域。

I, ________________________________ hereby give my permission to the veterinarian of Companion Animal Services to perform the operation on the animal as stated above. I also give my permission for the administration of anaesthetics and any treatment (including ear cropping and surgical operation) that the veterinarian may consider necessary on this animal. I understand that there are risks associated with the administration of general anaesthesia and surgical operation, and I appreciate that the veterinarian of Companion Animal Union will act at all time professionally. Therefore, I hereby irrevocably undertake nor to hold the veterinarian nor any person connected with the Companion Animal Union responsible should the operation be unsuccessful or if the animal is injured or dies or suffers any disability arising directly or indirectly from the operation or from the administration of anaesthetics or as a result of any treatment given to this animal whilst it is in your custody.
If I cannot pick up the animal 24 hours after the surgery, Companion Animal Services has the full right to rearrange adoption of the stray animal or send back to the place of origin.

 

簽署　　　　　　　　　　　　　　　　　　　　　　日期
Signature:_______________________________________  Date:__________________________

 

                                           流浪貓隻絕育手術須知  

1.        安排流浪貓隻絕育必須事先電話預約。

2.        義工須將手術貓隻安全放置於網袋中並送至伙伴動物公司(CAU) 獸醫診所辦理登記手續。

3.        獸醫視實際狀況或觀察後會替貓隻於當天或隔天進行絕育手術。

4.        手術費用: 公貓 200 母貓 400，手術前必須付清相關手術費用。

5.        獸醫會於手術中替貓隻進行剪耳。(雄 - 右耳; 雌 - 左耳)

6.        手術後貓隻於24小時內無人接回，伙伴動物公司(CAU) 可自行處置該動物，如安排領養或放回原捕捉區域。