Owner's Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Home Phone

Mobile Phone

Email *

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 *

Date *

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Euthanasia Consent Form

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