Blood Bank Screening Participation Agreement Form | Veterinary Emergency & Critical Care

I hereby authorize Veterinary Emergency + Critical Care, its’ veterinarians, technicians, assistants and qualified representatives to examine and draw blood from my pet for the screening process to potentially become a blood donor. I understand that this is the initial stage of the screening process and does not guarantee that my pet will be accepted into the donation program.
Initial:
I will provide current medical records pertaining to my pets’ health and authorize VE+CC to call for any records that may be needed. I understand that if my pet is not currently under the supervision of a primary veterinarian my pet will not be accepted into the donor program.
Waiver of Liability: I agree to hold Las Vegas Veterinary Referral Center harmless for any injury or damage to me, my family, or my pet as a result of the rendering of services by the hospital. I understand that there are risks involved in treating animals and I hereby agree to assume all risks arising out of the treatment of my pet by Veterinary Emergency and Critical Care.
Signature of guardian:
Printed name of guardian:
Date
Signature of witness:
Printed name of witness:
Date