What are you applying for?
Spay/NeuterEmergency Medical Assistance
First Name* :
Last Name :
Name of Rescue (if applicable):
Date of Birth:
How did you hear about paws?
Requesting assistance for:
If other, Please specify :
Annual income: $
# in household:
Other pets in household:
Are they all spayed/neutered?
Age: Years: Months:
Where did you get your pet?
AdoptedFound or GivenBought
If Adopted, where -
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:
Signature of Pet Owner (type in)*:
Enter the code
848 N. Rainbow Blvd. # 2922 • Las Vegas, NV 89107
Phone: (702) 666-0100 or (888) PAWSLV-1
Fax: (702) 666-0105
Paws LV | Pet Awareness and Welfare Services Las Vegas © 2017 | 848 N. Rainbow Blvd. Ste 2922 • Las Vegas, NV 89107
email@example.com | (702) 666-0100 or (888) PAWSLV-1 — Fax: (702) 666-0105