Individuals

Pet Awareness & Welfare Services (PAWS) Application

What are you applying for?

Spay/NeuterEmergency Medical Assistance


Pet Owner Information:


First Name* :


Last Name :


Name of Rescue (if applicable):


Street address:


City:


State:


Zip:


Phone:


Your Email*:


Date of Birth:


How did you hear about paws?


Requesting assistance for:
Spay/NeuterVaccinationOther

If other, Please specify :


Annual income: $


# in household:


Other pets in household:


Are they all spayed/neutered?

YesNo


Pet information:


Pet’s name:

DogCat

MaleFemale


Breed:


Weight: lbs


Age: Years: Months:


Where did you get your pet?

AdoptedFound or GivenBought

If Adopted, where -


Please Read Carefully

I/we the owner(s) of the pet named above, do hereby fully and completely release and discharge Pet Awareness & Welfare Services (PAWS) and all persons, agents, employees, directors and officers thereof and/or on its behalf liable from and against any and all actions, causes of actions, 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, neutering, or other medical services of my/our pet, 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 actions, claims, demands, assertions, contentions, suits, damages, expenses, and losses resulting from the foregoing activities.

By my signature below I certify the following:

  • I understand that Pet Awareness & Welfare Services (PAWS) Spay/Neuter or Emergency Medical Program is for pet owners in need of financial assistance.
  • The information provided in this application is accurate and complete and is subject to verification.
  • I understand that an approval of the voucher from Pet Awareness & Welfare Services (PAWS) does not guarantee that my pet will receive a spay/neuter surgery and that it is up to the veterinary clinic to decide if my pet is suitable for the surgery.


Signature of Pet Owner (type in)*:


Date*:


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