Microchip FORM

Microchip Form

If you need a chip before then next clinic please contact WMAW directly

Please keep your dog on a leash or in appropriate containers the whole time they are at the clinic.

Cats MUST be caged.

Online Registration is closed

Next event will be in the spring. If you need a chip faster please email WMAW

Prefered Appointement Time: (please indicate a time (11, 11:30, 12, 12:30, 1, 1:30)

Owner Name *

Phone Number *

Address *

Email *

I need a chip ($15 ea.) or I have a chip the # is (if you don't know the # we will get it to you at your apt) *

Payment - Day of (Cash/Check only) Pre-pay (use the button on this page>) *

Animal Name *

Species *

Gender (Male, Female) *

Spayed/Neutered - or not *

Birth date (Month / Year, or Year) *

Breed (up to 2) *

Animal 2 - Name

2- Species

2-Gender (Male, Female)

2-Spayed/Neutered or Not

2- Birth Date (Month / Year, or Year)

2- Breed of dog (up to 2)

Emergency Medical Info (diabetic, blind etc) Also any information you think WMAW should know (ex. Scared dog needs to be done in the car, not good with other dogs needs to be done outside). If multiple dogs please indicate which dog.

Thank you, WMAW is so happy to help keep your animal safe!

The owner name, email and phone number will all be used to set up you and your animal's account with www.found.org. They are a national chip registry that accepts any chip type and is connected to the national chip registry so your animal never gets deleted. They are Free for Life.

Checking a chip is free, but if you would like to give a donation to WMAW it's greatly appreciated

If you have more than 2 Animals please let us know in the bottom box. Please provide Name, Species, Gender, Birth date, and Breed (max 2 breeds)

This information may assist in a situation where your animal is at a vet and they can provide appropriate care. You can edit this on your account at a later time if things change.

**This form is not a payment form, If you want to pay now please go to the PayPal button on the right of this page.

Payments the day of must be cash or check. If you want to pay with credit card please pre pay with paypal