Euthanasia Consent Form Please enable JavaScript in your browser to complete this form.Owner's Name *FirstLastAddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome PhoneMobile PhoneEmail *Name of Animal *Species *Breed *DOB *Color *Sex *I, the undersigned, certify that I am the owner (or the duly authorized agent of the owner) of the animal described above, request, consent to, and order euthanasia to be performed on said animal. *I have read and understand.I give Elon Animal Hospital, its agents and representatives, full and complete authority to euthanize said animal in a humane manner and in accordance with the rules and regulations of this establishment. Furthermore, I release the veterinarian, representative, and hospital from any and all liability of said euthanasia. *I have read and understand.I understand that euthanasia is the act of ending the life of an animal in a painless way to prevent unnecessary suffering. *I have read and understand.I also certify that, to the best of my knowledge, the said animal has not bitten anyone in the past 10 days. *I have read and understand.Please select one of the following: *I, the undersigned, accept full and total responsibility for the remains following the procedure. I have read all applicable laws regarding disposal of remains, I understand the laws and the inherent dangers of disposing of animals that have been euthanized with chemicals.I agree to release the remains of said animals to Elon Animal Hospital and would like the cremated remains returned to me.I agree to release the remains of said animals to Elon Animal Hospital and would NOT like the cremated remains returned to me.Signature *Clear SignatureDate *NameSubmit