Euthanasia Consent and Liability Release Form

Helping Pets Cross Over The Rainbow Bridge From Home

Comfort, Dignity and Peace….

Right Time, Right Place….At Home™

EUTHANASIA CONSENT AND LIABILITY RELEASE FORM

Pet Owner's Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address

example@example.com

Pet's Name

Pet's Medical Condition

Euthanasia Consent:

I certify that I am the owner or authorized agent of the owner, for the above named pet. In being the owner/agent for this animal, I do hereby give SUGAR’S GIFT™ full and complete authority to perform euthanasia services by their contracted veterinarian.

Arrangements for aftercare will be based on the wishes of the owner/agent and documented below. I release the above named animal to SUGAR’S GIFT™ and/or their contracted veterinarian for:

Euthanasia - humanely terminate life (Please click the circle)

Aftercare Options:

I choose private cremation (pet’s cremains returned in a special Sugar’s Gift™ Urn in approximately 2 weeks. Sugar’s Gift™ Personnel will return the pet’s cremains to pet owner/agent)I choose to retain my pet for burial. (regulations have been discussed)I choose communal cremation. (pet’s cremains will not be returned)

How Did You Hear About Us?

To the best of my knowledge, the information I have provided on this form is true. I do also certify that my pet/owner's pet has not bitten, seriously scratched, or exposed anyone to rabies within the past 10 days. I understand that my wishes/owner’s wishes will be immediately carried out at the date of home visit. Again, by signing this form I am giving permission to humanely end my pet's life/owner’s pet’s life, and I have the authority to execute this consent.

I hereby forever release and hold harmless SUGAR’S GIFT™ and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposal of my/owner’s pet.

Signature

Printed Name

First NameLast Name

Date

Until We Meet Again…..™

MAIN OFFICE: 5910 Post Blvd #110571 ● Bradenton, FL 34211 ● 800-634-SUGAR ● 941-718-5066

SEE WEBSITE FOR OUR OTHER LOCATIONS AND CONTACT INFORMATION

NikkiStewart@SugarsGift.org ● www.SugarsGift.org

Owner's Information

Pet's Information