I, the undersigned, do hereby certify that I am the owner (or duly authorized for the owner) of the animal described above. I do hereby give the Companion Memorial Crematorium and their staff, and representatives full and complete authority to Cremate and handle the aftercare of said animal in whatever manner of Companion Memorial Crematorium of which cremation of choice.
I do hereby release the said Companion Memorial Crematorium, their staff, and representatives from any and all liability for cremation of said animal.
I do also hereby certify that to the best of my knowledge the said animal has not bitten any person or animal during the last ten (10) days and has not been exposed to rabies.