By my electronic signature below, I certify I am of 18 years of age or older. I have never been investigated or convicted of animal cruelty, neglect or abandonment. All information submitted in this application is true and complete. I agree to indemnify and hold harmless PCI, their officers, agents, and representatives, liable in any and all liability, loss, damage, cost, claims, and/or causes of action, including, but not limited to, all bodily injuries and property damage arising out of participation in PCI activities, events, and placements.
Signature: _____________________________________________________