Consent Form

I am the owner/agent of this pet.
This pet has not been exposed to rabies, nor bitten any person or animal in the last 10 days.
I give this veterinarian permission to euthanize this pet.
I release the veterinarian from all liability in performing this euthanasia.
I do convey the body to this veterinarian for cremation.

Check if you are agree

I authorize:

group cremation (no, I do not want ashes) individual cremation (yes, ashes saved & returned to me).

If selected, I release the veterinarian & crematorium from all liability in performing the pet cremation service.

Date

Owner/Agent Name:

Address: *

Owner/Agent Signature:

Email *

Pet's Name:

Species:

Breed:

Weight:

Veterinarian's Name: