Pet Euthanasia Form
Owner Information
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email Address
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tell us about your pet:
Name:
Species:
Breed:
Colour:
Age:
Gender:
Male
Female
Is your pet spayed/neutered?
Yes
No
Approximate weight:
Has your pet seen the vet in the past 12 months?
Yes
No
If yes, what is the name of the Veterinary Clinic?
Consent
*
I agree and understand I will not with my pet during the euthanasia. Due to space limitations at the facility, we want to be sure you understand you will not be able to be physically present with your animal during the euthanasia process
Consent
*
The Humane Society of Kitchener Waterloo and Stratford Perth is able to offer this service at an affordable cost to serve members of our community. Payment must be received prior to the appointment day via e-transfer. E-transfer information will be provided to you once an appointment has been confirmed.
Submit
Should be Empty: