I assume responsibility for all charges incurred in the care of this animal. I also understand that
these charges are to be paid at the time of release and that a deposit will be required prior to treatment.  

I HEREBY AUTHORIZE THE VETERINARIANS TO EXAMINE, PRESCRIBE FOR, OR TREAT THE ABOVE DESCRIBED PET(S). I ASSUME FULL RESPONSIBILITY FOR ALL CHARGES INCURRED IN THE CARE OF THE ANIMAL(S)