REGISTRATION FORM (outside territory)

This information is used to register the microchip. In the days following your appointment, the SPCA Roussillon will send your registration form to the microchip company.

1. OWNER'S DETAILS

Full name:

Address:

City:

Postal code:

Province:

Email address:

Please enter at least one phone number.

Home phone:

Work phone:

Mobile phone:

2. EMERGENCY CONTACT

A person to contact if you are not reachable

Full name:

Home phone:

Mobile phone:

3. PET'S DETAILS

Pet's name:

Date of birth (can be approximative):

Species:

CatDogRabbit

Sex:

FemaleMale

Neutered:

YesNo

Breed (for a cat: if you do not know the breed, please write Domestic short, medium, or long hair):

Colours, markings and other ID:

Notable conditions:

Declaration of ownership I hereby confirm, by submitting this form, that the animal which is presented for identification is owned by me/presented by me with the authority of the owner whose details are given above and on whose behalf I am authorized to do so.

Authorization: I understand that the information I have given on this form will be retained by M4S ID and hereby agree that it may be disclosed to any person or persons involved in securing the welfare of the pet above.

Data protection: I wish to receive offers from SPCA Roussillon and its partners, as well as pet products or services from M4S ID.
YesNo

There could be a delay of a few seconds after you click on NEXT STEP – Please do not leave this page, you still have to book your appointment and complete payment.

Suggestions of things to do while you wait: pet your cat, give a treat to your dog, check cute animal videos on your phone.
Thank you for your patience!