&= nbsp; &nbs= p; Transport Request plus Liability Waiver

For Intrastate and Interstate Comp= anion Animal

&= nbsp; &nbs= p; = Transport

This information is required before any transport plans = are made. Flying Paws volunteer p= ilots transport from airport to airport only.&nb= sp; Any required ground transportation is the responsibility of the send= ing and receiving parties. For lo= nger transports, sending and receiving parties must have a “standby foster” arrangement in place at any intermediate stop along the trans= port route in the event the transport must be aborted due to weather, mechanical= or other unknown events. Both the sending and receiving parties will be in clo= se contact with the Flying Paws Flight Coordinator as well as with the individ= ual pilot volunteer. 48 hrs befor= e the flight, a copy of all required documents must be faxed to the Flight Coordinator and the original documents including transport information, sta= te health certificate, proof of = shots, altering and microchip number must be given to the Flying Paws volunteer pi= lot before the flights departure or the flight will be canceled. All animals may not be sedated unl= ess a veterinarian is present at the airport to supervise and it is required due = to the animals veterinary medical transport specified on the Health Certificat= e. The safety and well-being of the companion animal in transport is Flying Paws major concern.

Sending Shelter or Rescue:

Contact Na= me: ___________________________________________ Day Phone:= ___________________

Organization: __________________________________________= __ Even= ing Phone: _______________

Street Address: ________________________________________= __ Cell= Phone: ___________________

City, State, Zip: ______________________________________= _____ Fax: _________________________

Alternate Contact Name/Phone: __________________________= ___ Email: _________= _______________

= &nb= sp; ____________________________________________

Shelter/Rescue URL:______________________________________

Transport Animal’s Veterinarian:=

Contact Name: __________________________________________= _    Day Phone: ___________= __________

Organization: __________________________________________= __    Evening Phone: _______= __________

Street Address: ________________________________________= __    Cell Phone: __________= ___________

City, State, Zip: ______________________________________= ____     Fax: ___________= ________________

Alternate Contact Name/Phone: __________________________= __     Email: _________= ________________

        =             &nb= sp; ___________________________________________

Vet Hospital URL:_______________________________________=

Receiving Rescue or Adopter:

Contact Name: __________________________________________=      Day Phone: _____= ________________

Organization: __________________________________________= _     Evening Phone: _= ________________

Street Address: ________________________________________= _     Cell Phone: ____= _________________

City, State, Zip: ______________________________________= ___      Fax: _____= ______________________

Alternate Contact Name/Phone: __________________________= _      Email: ___= _______________________

        =             &nb= sp; ___________________________________________

Rescue URL:____________________________________________

    =             &nb= sp;            =             &nb= sp;            =       Page 1 of 4

Page 2 Flying = Paws Transport Request plus Liability Waiver for Intrastate and Interstate Trans= port

General Information Needed for Transport Requests

Reason for Transport: (Circle the answer)    Forever Home,   another Rescue, Veterinary Transport,

    =             &nb= sp;       Hospice, Service Dog,   Legal Tran= sport

<= st1:PlaceName w:st=3D"on">Beginning City/ State: __________________________= ______________________________________

Ending City/State: _____________________________________= ______________________________

Desired Week of Transport: _____________________________= ______________________________

Breed of Animal: _______________________________________= ____    Weight: ______________= __

Sex: (Circle the Answer):    Male Neutered    Female Spayed        =            Age: __________________

Behavior Issues: (Circle the answer):   Calm   Hyperactive=     Fearful    Barky    Bites    Afraid of being

    =             &nb= sp;       Picked up,   not crate trained, = Leash trained, not leash trained, Runs, Any other issues

    =             &nb= sp;       ____________________________= ________________________________________

Special Handling Required: (Circle the answer):   None,   Blind,    Deaf, Physically handi= capped,

    =             &nb= sp;       Senior, Medications

Medical Information for Transport<= /p>

Micro chipped (Required): Number______________________________    Registered: __________= ____

Altering (Required):&nb= sp; Noted on Health Certificate or Rabies Certificate. Veterinarian Certificate needed if=

    =             &nb= sp;       Animal is not altered stating health reason why not altered.=

Rabies Vaccination:&nbs= p; Required on all animals over 3 months of age. Must provide Rabies Certificate.

State Health Certificate: Required on all transports crossin= g a State Line by ground or air.

DHPP Vaccinations: Date Given: ________________________   State on Health Certificate Current

Bordatella:   Date Given: ______________________________    State on Health Certif= icate Current

Heartworm Test: Date Done: ___________________________   Results: Positive    Negative

    =             &nb= sp;       Type of Heartworm Prevention: ________________________________________

    =             &nb= sp;       Date Given: ________________________________________________________<= /span>

Flea and Tick Prevention: Date Done: __________________    Type: ________________= ______

Allergies (Circle the answer): None     Food        Contact

Fecal test for worms (Circle the answer): None     Worms present

    =             &nb= sp;       Type of worms: _____________________________________________________<= /span>

    =             &nb= sp;       Treatment prescribed by Veterinarian: __________________________________

Feline Transports (Circle the answer): Following Tests are Required<= /o:p>

    =             &nb= sp;       FIV:   Positive, Negative

         &= nbsp;           &nbs= p; FIA:   Positive, Negative

    =             &nb= sp;       FIE: Positive, Negative

    =             &nb= sp;       FeLV: Positive, Negative

    =             &nb= sp;       FTLV: Positive, Negative

    =         Note: Veterinary Health Certificate must indicate results of the above tests.

Feline Rabies: Date Given :_______________________( Required) Rabies Certificate

Allergies (Circle the answer): None    Food       Cont= act

Fecal Test for worms (Circle the answer): None    Worms Present

        =             &nb= sp;   Type of worms: ________________________________________________=

    =                 = Treatment prescribed by Veterinarian: ______________________________= _________

Fleas/ Ticks Present:   Yes     No       Trea= tment: ___________________________________________

Our Concern about Sick or Infected Animals: Read Carefully

Flying Paws insists that an animal be free of all illness and has not been in the presence of a contagious disease or, if an illness = or exposure is present, that Flying Paws is made fully aware of the illness pr= ior to arranging or performing a transport.&nb= sp; This is an issue of major concern to Flying Paws. Transportation of an infected anim= al can result in a plane being contaminated and make the plane unsuitable for anim= al transport for periods up to one year. Any individual or organization that knowingly provides an ill/infect= ed animal for transport will be liable for the cost of any decontamination tha= t is required to make the plane suitable for transport and will be permanently barred from transporting animals by Flying Paws. If an animal is transported and you later become aware that the animal is ill, infected, or exposed to a disease that is contagious to animals or humans, you must contact Flying Paws immediately and provide

Page 2 of 4            =             &nb= sp;            =             &nb= sp;

Page 3 Flying = Paws Transport Request plus Liability Waiver for Intrastate and Interstate Trans= port

all availa= ble information including veterinary contacts.= Failure to provide this information will permanently bar the individ= ual and the organization that the individual represents from transporting =

animals by Flying Paws.= The cost of decontamination of the airplane will be born by the individual releasing the animal for transport. By providing an animal for transpo= rt, you and the organization you represent are automatically agreeing to comply with the statements in this section on ill/infected animals. If you do not agree with these statements and/or are unwilling or unable to comply, then do not submit an animal for transport.

If transport is for veterinary medical reasons or the animal has a medical condition then the follo= wing are required:

v Veterinary information, veterinary health certificate and copies of all veterinary records.<= /i>

v Veterinary detailed description of = the medical condition

v All medicines, correctly labeled in= the original container with the veterinary hospital identification.   Specific directions for administering and times of admistration.

v Careful and complete veterinary lab= els on all medicines transported giving the name of the animal, veterinarian prescribing, along with dosag= e to be give, time to be given, me= thod of giving, refrigeration need= ed or not, and name of medicine

v Short description of any potential behavior or information which you and your veterinarian feel is important f= or the transporting or handling of the animal

v Any sedation must be given by the veterinarian for medical reasons and given at the airport in the presence of the pilot so that flight altitude and oxygenation can be discussed with the veterinarian before the flight.

Liability Waiver for Shelters and Rescues Sending Animals for Flying Paws Transport

I, the undersigned, understand that Flying Paws is a volunteer organization, voluntarily providing free air transportation by pr= ivately owned or rented aircraft for special needs rescue animals and are not financially reimbursed for the expenses of the flights. Flying Paws members provide help w= ith promotions, educational programs or emergency fosters for animals in transp= ort and are not financially reimbursed for any personal expenses. I, the undersigned, agree to waive and do waive and release Flying Paws, its offic= ers, directors or other volunteers from any and all claims including, but not limited to, liability for negligence, any personal injury or property damage that might be suffered, and an wrongful death actions which an estate might bring, arising out of injury during any Flying Paws flight or activity. It is understood and acknowledged = that my signing this Waiver of Liability is bound and effective for any and all Flying Paws flights or activities. I further understand that the pilot in command (PIC) of a Flying Paws flight has the final decision concerning the cancellation of the flight due= to weather, mechanical problems or for any reason whatsoever, if in their judg= ment the flight can not be completed in a safe manner. The providing of this transportati= on is totally voluntary and if there is any reason whatsoever that the flight can= not be completed in a safe manner; the flight will be cancelled or postponed. I also understand that that all an= imals must be transported in appropriate kennels and/or cages and must be accompa= nied by all required paperwork. Ke= nnels are provided by the Flying Paws pilots to fit in their specific aircraft and remain the property of the pilot. If a feline is to be transported, it must be in a kennel provided by= the rescue.

I, the undersigned, do herby certify that I am legally a= ble to release the above named/described animal and all of its documents for transport to the receiving entity. I furthermore, understand and give authority to Flying Paws to deter= mine if any changes must be made in the transport for flight or animal safety an= d to make such changes. Should the animal become ill during transport or any question concerning the health of= the animal in Flying Paws care during a transport arise, the pilot has the authority to make decisions regarding whether the animal will be taken to t= he nearest veterinary facility (emergency landing) or whether the flight will continue to its next fueling or overnight destination where veterinary care will be instituted. If an animal’s health or condition is questioned by the pilot at any time, = transport will continue only after a veterinarian has determined that continued trans= port will in no way endanger the animal, pilot or airplane. Should such a decision be made by = the pilot, the animal will not be released to any person until the veterinarian certifies that the animal is healthy and that the reason for the need for veterinary care is corrected. I, the responsible person releasing the animal for transport, understand that = I or the organization I represent are responsible for all veterinary costs that result from the pilot’s decision to seek veterinary consultation and = care for the animal in transport. = I will be contacted should

&nb= sp;            =             &nb= sp;       Page 3 of 4

Page 4 Flying = Paws Transport Request plus Liability Waiver for Intrastate and Interstate Trans= port

this occurs by a Flying Paws representative after the an= imal is receiving veterinary care. I forever release

Flying Paws, its agents, pilots or anyone involved in the transport of this animal from all liability for <= /p>
transporting and caring for this animal and from any liability resulting from previous actions of the animal/or agents.

I understand the animal:

1)&n= bsp;   Must receive a small amount of food and water at least one hour before the fligh= t.

2)&n= bsp;   Must have been walked and allowed to relieve itself during the hour before flight and before boarding the plane.

3)&n= bsp;   Must have a harness and leash on (for flight safety)
4)&n= bsp;   Must travel in a kennel during the flight

5)&n= bsp;   Can have a toy, blanket or something which the animal is familiar with in the kennel provided that there is room in the kennel.=

I,______________________________________________________= __,(responsible party, release for transport the animal described above to the designated Flying Paws pilot at a time and place mutually agreed upon by the parties.<= span style=3D'mso-spacerun:yes'> At the destination airport, this a= nimal is to be released to

________________________________________________________= _, (name of person) who is the adopter, or representative of shelter (_______________________________________________________) or veterinary hospital (______________________________________________________________).<= o:p>

Signature: _____________________________________________= ______   Date: ____________________

Printed Name: __________________________________________= _________

Please Fax this completed form to Flying Paws at 928-636= -7151 at least 48 hrs before the flight. Include copies of the Health Certificate= and Proof of Rabies.   The originals must be given to the = pilot.

Release of the Animal at Destination

I, _____________________________________________________= ____ a representative of

______________________________________________________ received ___________________________

At ___= _________________________________________ Airport on _________________________________.

Signature: _____________________________________________= _______ Date: _______________________

Printed Name: __________________________________________= ________

    =             &nb= sp;            =             &nb= sp;            =       Page 4 or 4

Email contact for Flying Paws Transports only: Transports@att.net