Euthanasia / Cremation Authorization Form

Owner's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Pet's Name*

I certify that I am the owner or the authorized agent for the owner of the pet described above and give Thurman Veterinary Center, the doctors and staff full and complete authority to euthanize my pet. I understand that euthanasia is the act ending the life of an animal in a painless and humane way. Arrangements for aftercare will be based on the wishes of the owner/agent and documented below. I release the above name animal to Thurman Veterinary Center for:

Please Elect the Following Procedures*

I choose to retain my pet for burial (Regulations have been discussed)I choose routine cremation (NO ASHES RETURNED BACK TO OWNER) for an additional charge based upon the pets weight.I choose private cremation for the additional charge based upon the pets weight. You will be notified in 3-4 weeks when the ashes have been returned from the crematorium

Clay Paw Print: Clay keepsake featured in a leather case ($48)*

Yes, I would like a clay paw print.No, I decline a clay paw print.

Engraved Name Plate: I choose to have an Engraved Name Plate added to the urn for an additional charge of $20 ( gold or silver, Lucinda or Times New Roman)

Yes, I would like an engraved name plate.No, I decline an engraved name plate.

Authorization:

To the best of my knowledge, the information I have provided on this form is true. I do also certify that my animal has not bitten, seriously scratched or exposed anyone to or has been exposed to rabies within the past 10 days.
I understand that my wishes will be immediately carried out upon signing this agreement. Fees for these services have been explained to me and will be collected at the time of service.

Owner/Agent Signature:*

Clear

Date:

Date