Owner Information

Animal Information

Please Read and Agree to the Following

I hereby authorize and direct the Oregon Coast Humane Society to implant a microchip in my pet listed above. I fully release the Oregon Coast Humane Society, its employees, and its agents from any legal and financial responsibilities, claims, demands, damages or actions arising from micro chipping. 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 including any necessary veterinary care and the costs incurred thereof.