WAG Spring Health Clinic 2017

WAG Spring Health Clinic 2017

SUNDAY March 5

Health Screening 9:00-2:30

Eye Clinic 11:00 - 1:00

2807 N Hwy 12 (Our NEW building) ~ Spring Grove, Il 60081~ 847-675-9300

Health Screening: Veterinarian Dr Richard Sholts, DVM / Cost
Heartworm (Standard Test) / $30
Heartworm SNAP(includes Lymes, Erlichia, Anaplasmosis) / $40
PreVaccination Screening: parvo/distemper
(Pos/Neg only- no numerical values) / $85
PreVaccination Titer: parvo/distemper(numerical values) / $125
Rabies Shot* - 3 year (must show proof of last vaccination) / $25
Rabies Shot *- 1 year / $25
DHLPP(with lepto) or DHPP (without lepto)
(circle one ) / $30 / $25
(+ lepto/ - lepto)
Microchip- Home Again(chip only)
(You will be responsible for submitting the registration) / $25
Eye- OFA CERF: VeterinarianDr Annora Gaerig, DVM / $45

*Rabies certificates will be issued- you will be responsible for obtaining a tag

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PLEASE FILL OUT, CHECK AGREEMENT AND SIGN YOUR FORM (page 2).

YOU MAY PAY ALL YOUR HEALTH CLINIC FEES WITH 1 CHECK.

CONFIRMATIONS WILL BE SENT VIA EMAIL

CHECK PAYABLE TO: WAG

MAIL or EMAIL COMPLETED FORM (Page 2) TO: Kathi McBride4916 Brockham Ct, Woodstock, IL 60098

IF YOU EMAIL- YOU MUST BRING CHECK/CASH- NO TESTING WITHOUT PAYMENT IN FULL – NO EXCEPTIONS

NO-SHOW/CANCELATION WITHOUT CREDIBLE REASON WILL NOT BE GRANTED A REFUND

REQUEST for REFUNDS MUSTOBTAIN PRIOR APPROVAL FROM JOY NO LATER THAN 5pm SATURDAY MARCH 4 JOY: (262) 705-4670

Cancelation Policy

NATIONAL WEATHER SERVICE- SEVERE WEATHER WARNING

~ CLINIC WILL BE CANCELLED ~

~ PARTICIPANTS WILL NOT BE CHARGED- CHECKS WILL BE SHREDDED ~

Any other questions contact WAG event coordinators: JOY or KATHI

FORM

WAG Spring Health Clinic 2017

CHOOSE YOUR PREFERRED TIME SLOT (CIRCLE two) YOU WILL BE EMAILED WITH ENTRY & TIME SLOT CONFIRAMATIONS. WE WILL TRY OUR BEST TO MEET YOUR TIME PREFERENCE. (Eye clinic will start @ 11:00 – please come 10 min early foreye drops)

9:00 to 10:00 10:00-11:00 11:00 to 12:00 12:00 to 1:00 After 1:00 ANY TIME

* NAME ______

* EMAIL ______

* Dog call name/ approx. weight (for HW med)/ Breed / Birth MM/YY 1______

2______3______4______

5______6______7______

Health Screening: Veterinarian Dr Richard Sholts, DVM / Cost / Number of dogs / Total Fee
(# dogs x item fee)
Heartworm (Standard Test) / $30
Heartworm SNAP
(includes Lymes, Erlichia, Anaplasmosis) / $40
PreVaccination Screening
(Pos/Neg no numerical values: parvo/distemper) / $85
PreVaccination Titer
(numerical values: parvo/distemper) / $125
Rabies Vaccination (1 yr ) / $25
Rabies Vaccination (3 yr) (proof of previous vax req’d) / $25
DHLPP (with lepto) / $30
DHPP (without lepto) / $25
Microchip- Home Again / $25
Eye - OFA CERF: Veterinarian Dr Annora Gaerig, DVM / $45
Please make Check payable to WAG / TOTAL

STATEMENT OF UNDERSTANDING: As with any medical or surgical procedure, there is a slight risk including anaphylaxis that may be associated with these vaccinations and other medical procedures.

☐ I UNDERSTAND (KINDLY CHECK) I (we) agree to hold Wi-Il Agility Group (WAG), their members, directors, officers, and the owner and/or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the event premises or grounds or near any entrance thereto; and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the afore mentioned parties harmless from any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or inconsequence of my (our) participation in this event, however such, injuries, death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other persons.

I AM AN AUTHORIZED OWNER OF THIS DOG AND I HAVE READ THE AGREEMENT ABOVE. BY SIGNING, I AGREE TO THE TERMS AS STATED.

SignDate

PLEASE FILL OUT, CHECK AGREEMENT AND SIGN THIS FORM. YOU MAY PAY ALL YOUR HEALTH CLINIC FEESWITH A SINGLE CHECK. PLEASE MAKE CHECK PAYABLE TO: WAG

MAIL or EMAIL COMPLETED FORM TO: Kathi McBride 4916 Brockham Ct, Woodstock, IL 60098