Solace Release Form - Revised 06.20.24

RELEASE FORM
WE KNOW HOW MUCH YOUR PET MEANT TO YOU. WE THANK YOU FOR TRUSTING US WITH YOUR PET'S AFTERLIFE CARE. TO HELP US PROVIDE THE BEST CARE POSSIBLE, PLEASE TAKE A FEW MOMENTS TO FILL OUT THIS FORM COMPLETELY. AQUAMATION IS AN IRREVERSIBLE AND FINAL PROCESS SO IT IS IMPORTANT THAT YOU UNDERSTAND THE PROCESS AND THE OPTIONS AVAILABLE PRIOR TO RELEASING YOUR PET INTO OUR CARE.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

Parish

Postal Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Other)
Please enter a valid phone number.Format: (000) 000-0000.
Email*
If using a hotmail account please check SPAM folder for correspondence
PET INFORMATION
NAME OF PET*
Small Pet (Hamsters, Guinea Pigs, Rabbits)CatDog
FemaleMale
BREED AND COLOUR *
AGE*
WEIGHT (LBS)*
DATE OF DEATH*

MonthDayYear
Date
SOLACE HAS PERMISSION TO PICK MY PET UP FROM*
AFTERLIFE SERVICES AND KEEPSAKES
AFTERLIFE SERVICES - USE THE DROP-DOWN MENU TO SELECT THE SERVICE YOU WOULD LIKE FOR YOUR PET
KEEPSAKES
KEEPSAKES
KEEPSAKES
RELEASE AND AUTHORIZATION
I agree to release and indemnify Solace Aquamation (Bermuda) Ltd., their officers, agents and employees from any claim, liability, cost or expense resulting from their reliance on or performance consistent with the directions, declarations, representations, authorizations and agreements herein. We agree that the liability for negligent acts, errors or omissions shall be limited to a refund of the aquamation fees paid by us. We warrant that all representations and statements contained in the form are true and correct and we have read and understood the services being offered.I understand that late fees may be incurred for payment not received by Solace Aquamation Bermuda Ltd. as per the terms on the invoice.I understand that full payment will be due prior to the Aquamation Service that has been selected above.
SIGNATURE*

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DATE OF SIGNAURE*

MonthDayYear
Date
OFFICE USE ONLY

Collected by Date / Time __________

Returned Date / Time ____________________________________________
Should be Empty:

RELEASE FORM

PET INFORMATION

AFTERLIFE SERVICES AND KEEPSAKES

RELEASE AND AUTHORIZATION