Euthanasia Authorization Form

Euthanasia Authorization Form
Owner's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Pet's Name*
Species/Breed*
Male or Female
Age*
Color*
I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal described above. I do hereby give the doctors of Aardvark Animal Hospital LLC permission to euthanize and dispose of said animal in whatever humane manner the doctors of Aardvark Animal Hospital LLC, their agents, servants or representatives deem appropriate. I also release the doctors, Aardvark Animal Hospital LLC, their agents, servants and representative from any and all liability for so euthanizing and disposing of said animal.

I also certify that to the best of my knowledge the said animal has not bitten any person or animal during the last fifteen (15) days and has not been exposed to rabies.
Deposition of Remains:*

Private Cremation - Ashes ReturnedCarved Rosewood Urn BoxClassic Paw Print UrnPhoto Box UrnClay PawprintClay Nose PrintCommunal Cremation - No Ashes ReturnedClient to Take RemainsOther
Signature*

Clear
DateTime*
Should be Empty: