Transportation Release Form

Spay/Neuter Transport Info/Release Form

Today's Date

Pet Owner's Name *

First

Last

Additional Pet Owner's Name *

First

Last

I hereby freely and voluntarily provide my consent for Hoosier Fix volunteers to take possession of my pet(s) for transport to IndyHumane's Clinic at 456 N. Holmes Avenue, Indy 46222 for the purpose of having my pet(s) spayed/neutered and vaccinated.

I hereby freely acknowledge and understand that accidents may occur while transporting my pet(s) and it is possible that my pet(s) may escape or be injured and also that permanent loss or death of my pet(s) may occur. I freely and voluntarily accept this risk and will not hold Hoosier Fix or its volunteers or any agent thereof responsible for the loss, injury or death of my pet(s) during their lawful possession thereof, especially while transporting my pet(s) to and from the spay/neuter clinic.

I understand that I need to be ready for my pet(s) to be picked at the designated morning time and/or be available for taking possession of my pet(s) when returned from the clinic.

I understand that I need to have my pet(s) contained in a carrier (cat) or on a leash (dog) when the volunteer is set to arrive for pickup.

I have carefully read this waiver of liability agreement and fully understand and agree to the contents thereof. Please type your full name in the box below. *