Euthanasia

Pet Owners Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Pets Name*

Species*

Breed*

Color*

Weight Range*

Will you be taking your pet home for burial or leaving with us for cremation?*

I will be taking my pet homePlease have my pet cremated

Would you like to have your pets cremated remains returned to you?*

Yes, please have my pets cremains returned to me ("Individual cremation")No, I do not want my pets cremains returned to me ("Communal cremation")

Please note exactly how you would like your pets name engraved on their box*

Your pet will be cremated by Guardian Animal Aftercare and returned to us in an urn of your choosing in approximately 1 week. Our office will call you when they arrive.

Additional Options

Clay paw print impression (your pets paw on a clay disc) $55.00Nose and paw ink print (your pets nose and paw, stamped in ink on paper) $35.00Other

Additional Clay Paw Print Options

Lock of pets fur added to clay discOther

I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above; that I do hereby give John Gonda, DVM, his agents, servants, and representatives full and complete authority to euthanize the said animal in whatever manner the said Doctor, his agents, servants, or representatives shall deem fit.

I do hereby, and by these presents forever release the said Doctor, his agents, servants, or representatives from any and all liability for so euthanizing the said animal.

I do also certify that the said animal has not bitten any person or animal during the last fifteen (15) days, and to the best of my knowledge has not been exposed to Rabies.

Signature*

DateTime

Euthanasia and Aftercare Authorization