Pet Owner Authorization and Consent Form

PET OWNER AUTHORIZATION AND CONSENT FORM

I, the undersigned, hereby authorize Pet Lifeline Chicago, Inc. and its designated representatives to provide transportation and related assistance for my pet(s).

PET INFORMATION:
Pet Name(s): ________________________________
Species/Breed: _______________________________
Medical Conditions: __________________________

AUTHORIZATION & CONSENT:
1. I represent that I am the legal owner or authorized caretaker of the pet(s) listed above.
2. I authorize Pet Lifeline Chicago, Inc. to transport my pet(s) to and from scheduled veterinary appointments or other necessary locations as agreed upon.
3. In the event of an emergency during transport, I authorize Pet Lifeline Chicago, Inc. to seek immediate veterinary care at the nearest available facility. I understand that I am responsible for all medical costs incurred.
4. I release Pet Lifeline Chicago, Inc., its board members, employees, and volunteers from any and all liability related to the transport of my pet(s), except in cases of gross negligence.

ACKNOWLEDGEMENT:
I have read and understand this authorization and consent form. I acknowledge that I am providing this authorization voluntarily based on the needs of my pet(s) and my personal circumstances.

Owner Printed Name: __________________________

Owner Signature: ______________________________

Date: _______________________________________