SIGNATURE OF OWNER/AUTHORIZED AGENT - Please sign your name and date using your mouse or stylus in the box above, to be initialed at time of drop-off on our printout of this form.
The above signed hereby warrants that he/she is the owner, or authorized agent for the owner, of the above named animal(s) and does hereby request, consent and authorize CENTER-SINAI ANIMAL HOSPITAL, its veterinarians, and staff, to board, care for and treat the said animal.
The above signed acknowledges that no guarantees have been made except reasonable precautions against injury, escape, or illness with the understanding that the undersigned will remain fully responsible for the cost of all services provided by CENTER-SINAI ANIMAL HOSPITAL, its veterinarians, and staff.