I certify that I am the legal owner/duly authorized agent for the owner of the animal described above and do hereby give Monroe Veterinary Clinic and any authorized agents, staff, or representatives consent to euthanize and dispose of said animal in a humane manner. 

I hereby forever release and hold harmless Monroe Veterinary Clinic and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposal of the animal listed above.

To the best of my knowledge and belief my pet has not bitten any person in the last fifteen (15) days. 

 I understand that euthanasia is the act of ending the life of an animal in a painless way to prevent any unnecessary suffering. To the best of my knowledge, the information I have provided is accurate and complete. I understand that my wishes may be carried out immediately upon my signing of this agreement. Fees for these services have been explained to me, and I assume full responsibility for all charges applicable to such services. I have carefully read and fully understand the foregoing provisions.