For value received, I/we the owner(s) of the above-designated cat(s) and/or dog(s), do hereby fully and completely release and discharge Spay-Neuter Services of Indiana, Inc. and all persons, agents, employees, directors and officers thereof and/or on its behalf liable from and against any and all actions, causes of action, claims, demands, assertions, contentions, suits, damages, expenses, and losses of any kind and description which in any manner pertain to, concern, involve or relate to the spaying or neutering of my/our pet(s), including such pet's death or injury, and I/we agree to indemnify and hold harmless all entities and persons being released hereunder from and against any and all actions, causes of action, claims, demands, assertions, contentions, suits, damages, expenses, and losses resulting form the foregoing activities.

By checking the box below I certify the following:

• I understand that Pet Friendly Services of Indiana's Spay-Neuter Assistance Program is for limited income pet owners per the qualification guidelines.
• The information provided with the application is accurate and complete.
• I understand that my application is subject to verification.