Euthanasia Authorization Form
Pet's Name
*
Breed/Color
Age
Owner's Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
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 doctors of Petnership Veterinary Care, their staff, and representatives full and complete authority to euthanize said animal in whatever manner the said doctors and staff of Petnership Veterinary Care deem fit.
I do hereby release the said doctors of Petnership Veterinary Care, their staff, and representatives from any and all liability for euthanizing and aftercare 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.
I also wish for the aftercare of said animal to be handled in the following way:
Returned to me
Cremated communally arranged by Petnership Veterinary Care with no ashes returned
Cremated privately arranged by Petnership Veterinary Care with ashes and pawprint returned to me
Date
-
Month
-
Day
Year
Date
Signature
Can use mouse to sign - if not on touch screen
Submit
Should be Empty: