Registration for Saturday, April 11, 2026 FREE Vaccine and Microchip Clinic sponsored by Friends of MADACC 2026 Online Vaccine Clinic Sign-Up Sheet Instructions Please fill out the form below. If you have multiple animals, you will need to fill out an Animal Profile for each one. Click submit when you are finished and a member of the MADACC team will get back to you to finalize the information. Owner Name * Owner Name First First Last Last Address * City * Zip * Email * Phone * Animal 1 * Choose oneDogCatNew Option Name * Sex * Choose oneMaleFemale Sterilized? * Choose oneYesNo Breed * Color * Age * Choose closest approximate age1234567891011121314151617181920 Services Requested Today * Rabies Dog Combo Vaccine (DHPP) Cat Combo Vaccine (FVRCP) Microchip Friends of MADACC Services you are interested in Free Spay/Neuter Nail Trim Community Resources (Food, collars, harnesses, leashes, litter, other supplies) Animal 2 Choose oneDogCatNew Option Name Sex Choose oneMaleFemale Sterilized? Choose oneYesNo Breed Color Age Choose closest approximate age1234567891011121314151617181920 Services Requested Today Rabies Dog Combo Vaccine (DHPP) Cat Combo Vaccine (FVRCP) Microchip Friends of MADACC Services you are interested in Free Spay/Neuter Nail Trim Community Resources (Food, collars, harnesses, leashes, litter, other supplies) Animal 3 Choose oneDogCatNew Option Name Sex Choose oneMaleFemale Sterilized? Choose oneYesNo Breed Color Age Choose closest approximate age1234567891011121314151617181920 Services Requested Today Rabies Dog Combo Vaccine (DHPP) Cat Combo Vaccine (FVRCP) Microchip Friends of MADACC Services you are interested in Free Spay/Neuter Nail Trim Community Resources (Food, collars, harnesses, leashes, litter, other supplies) Animal 4 Choose oneDogCatNew Option Name Sex Choose oneMaleFemale Sterilized? Choose oneYesNo Breed Color Age Choose closest approximate age1234567891011121314151617181920 Services Requested Today Rabies Dog Combo Vaccine (DHPP) Cat Combo Vaccine (FVRCP) Microchip Friends of MADACC Services you are interested in Free Spay/Neuter Nail Trim Community Resources (Food, collars, harnesses, leashes, litter, other supplies) Animal 5 Choose oneDogCatNew Option Name Sex Choose oneMaleFemale Sterilized? Choose oneYesNo Breed Color Age Choose closest approximate age1234567891011121314151617181920 Services Requested Today Rabies Dog Combo Vaccine (DHPP) Cat Combo Vaccine (FVRCP) Microchip Friends of MADACC Services you are interested in Free Spay/Neuter Nail Trim Community Resources (Food, collars, harnesses, leashes, litter, other supplies) Waiver Part 1 I, the undersigned, have read and understand this entire page and authorize Milwaukee Area Domestic Animal Control Commission (MADACC) to administer the selected vaccination(s) to my pets listed above. I am aware of the potential benefits and risks of these vaccinations. I understand that having my pet vaccinated at MADACC in no way replaces the veterinary care provided by a traditional veterinary clinic or constitutes a patient/owner/veterinarian relationship between myself and MADACC. If your pet experiences any symptoms of illness or irregular behavior after receiving the vaccination, you should contact your veterinarian immediately, as your pet may require additional medical treatment. MADACC is not a veterinary clinic and does not provide public veterinary services outside of vaccine clinics and spay/neuter services. In consideration for my pet(s) being vaccinated and/or microchipped at the Milwaukee Area Domestic Animal Control Commission (MADACC), I, on my behalf and on behalf of my heirs, assigns, successors, personal representatives, and next of kin, hereby: 1. RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE MADACC, its officers, directors, employees, agents, servants and representatives (hereinafter collectively referred to as “Releasees”) FROM ALL LIABILITY TO ME, my heirs, assigns, successors, personal representatives and next of kin, FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO ME, MY PET(S) OR MY PROPERTY DURING, PRIOR TO, ARISING OUT OF OR AFTER THE VACCINATION/MICROCHIPPING OR RESULTING IN MY PET’S DEATH ARISING OUT OF OR RELATED TO THE VACCINATION/MICROCHIPPING, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES, THE NEGLIGENCE OF SOMEONE ACTING ON BEHALF OF THE RELEASES, OR THE NEGLIGENCE OF SOMEONE ELSE. 2. INDEMNIFY AND HOLD HARMLESS the Releasees FROM ANY AND ALL ILLNESS AND/OR INJURIES SUSTAINED AND/OR LOSS, LIABILITY, DAMAGE OR COST incurred by me or my pet(s) during, prior to, arising out of or after the vaccination, WHETHER CAUSED BY THE NEGLIGENCE OF MADACC OR ITS EMPLOYEES, THE NEGLIGENCE OF SOMEONE ACTING ON BEHALF OF MADACC OR ITS EMPLOYEES, OR THE NEGLIGENCE OF SOMEONE ELSE. I further attest that: (please check all that apply, if you cannot check all boxes you will not be able to participate in this clinic) * My pet(s) has/have not bitten anyone in the past 10 days My pet(s) is/are not pregnant My pet(s) has/have not had a reaction to any previous vaccine My pet(s) does/do not have a chronic medical condition My pet(s) has/have not been sick or shown any symptoms of illness or irregular behavior during the past week prior to the clinic I understand that if I do not attend this event that I will not be able to reschedule and any license purchase will be refunded Waiver Part 2 I HAVE READ THIS WAIVER AND RELEASE FROM LIABILITY, ASSUMPTION AND RISK, AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS AND NEGOTIATE OR BARGAIN THE TERMS, AND HAVE SIGNED IT FREELY AND VOLUNTARILY. Please check the box indicating that you are over 18 years old. Then by checking I AGREE below and typing my name in the SIGNATURE box I am agreeing to the terms of this waiver. * I am over 18 years old I AGREE to terms and conditions in the waiver Signature, type your name in below * signature keyboard Submit If you are human, leave this field blank.
