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Euthanasia Consent Form
APPOINTMENT
7
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Owner’s/Agent’s Name
*
First
Last
Date
*
Email
*
Phone
Pet's Name
*
Pet's Weight
*
After Care Arrangement Options:
*
I will handle and take full responsibility for all aftercare arrangements myself. I am aware of any applicable laws and regulations regarding the burial of a pet’s body and understand caution should be taken when disposing of animals euthanized with drugs/chemicals.
I wish to have The Welcome Waggin’ arrange for my pet’s aftercare (you must select one of the following options below)
Please select one of the following:
*
Communal Cremation (no ashes returned)
Private Cremations with ashes returned to me
Other Requests:
I certify that I am the legal owner/duly authorized agent for the owner of the animal described above, and do herby give The Welcome Waggin’ and any authorized agents, staff, or representatives full and complete authority to euthanize and dispose of said animal in a humane manner. I hereby forever release and hold harmless The Welcome Waggin’ and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposal of said animal.
*
I have read, understand, and authorize.
To the best of my knowledge, my pet has not bitten, scratched, or otherwise potentially exposed any person or other animal to rabies in the past ten (10) days. I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test must be performed.
*
I have read, understand, and authorize.
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 signing 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.
*
I have read and understand.
Owner/Agent's Signature
*
Clear Signature
Date
*
Are you the owner or agent?
*
Owner
Agent
Owner/Agent Printed Name
*
Witness Signature
Clear Signature
Date
Witness Printed Name
Name
Submit
