In consideration of, and as partial payment for the transportation of

,
(Animal Name)

by Darren Bates and/or Angela Bates doing business as, and hereinafter referred to as "Purple Sage Coach".

I, hereby assume all risk of loss, injury of damage, or DEATH of, said animal regardless of the cause thereof while in the care, custody or control of Purple Sage Coach. I hereby release and hold harmless Purple Sage Coach and their employees and agents from, and indemnify them against any and all connection with the transportation of said animal by Purple Sage Coach or while said animal is in the care, custody or control of Purple Sage Coach.

Check here if you agree.

(Owner or Agent Signature)

(Date)

Please note that electronic submission (online) requires that the legal owner or agent MUST be the one to submit this form.