Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Animals Name *Animals Age *Animals Breed: *Date *Customer Signature *Medical Release and Disclaimer *I accept the terms and conditions of the Medical Release and Disclaimer belowThis is a medical release form that all shippers are required to sign for their animals to board with us. This will ensure us and you that should your animal need medical attention for any reason during transport; it will be administered by a veterinarian. At any time during transport should a P.E.T.S. driver deem it necessary for my pet to receive medical attention, I give my permission for them to seek treatment by a veterinarian. I agree to pay all charges incurred. Every effort will be made to contact me by phone so I may be the decision maker for my pets’ medical treatment. Pet Express Transport Service ensures your pet(s) for $100.00, free of charge, if we are in an accident, if we lose your pet(s), or if your pet(s) should be stolen. However, we are not insured nor are we responsible for any health or illness issues with your pet(s). Please be aware, older pets especially, can have inherent health issues and can become stressed in any new or strange situation that could exacerbate these health problems. Our drivers will do everything humanly possible to make sure your pet(s) is comfortable and cared for properly. However, you as the shipper/receiver, having been made aware of this fact, agree by your signature on this document to hold Pet Express Transport Service, in the event of your pets’ demise due to illness, or communicable disease, harmless and without blame. I understand that submitting this form makes this a legal and binding document. Submit