Euthanasia Authorization

"*" indicates required fields

Owners Name*

First Last

Today's Date:*

Owner's Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Owner's Phone:*

Owner's Email*

Animal Name:*

Date of Birth:*

List*

Sex:

Breed

Color

Please Upload ID of Owner/Agent on this form to confirm you are the person signing the form. If you cannot upload the ID, please provide it at time of check-in.*

Max. file size: 60 MB.

Your Name:*

First Last

Your Signature:*

Please Select The Services You Want Performed:*

Taking Home

Private Cremation – REMAINS MUST BE PICKED UP WITHIN 30 DAYS FROM EUTHANASIA

Body Care

Wants to be present

Date Submitted:*

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