Authorization For Euthanasia/Cremation
Please read through this entire page, and enter your information and accept the terms as stated.
This authorization form is required to be completed and signed prior to the euthanasia and/or final disposition of your pet. Euthanasia and cremation are irreversible and final processes.
I certify that I am the legal owner or authorized agent for the owner of the pet described above and give Kindest Farewell and any authorized agents, staff or representatives full and complete authority to euthanize and/or facilitate cremation services for my pet. I forever release and hold harmless Kindest Farewell and any authorized agents, staff or representatives from any and all liability for euthanasia and aftercare.
If I do not choose aftercare through Kindest Farewell, I will handle and take full responsibility for all of the aftercare arrangements myself. I am aware of any and all laws and regulations regarding the burial/disposition of my pet and understand caution should be taken when handling a pet euthanized with drugs/chemicals.
To the best of my knowledge, my pet has not bitten, scratched and/or potentially exposed any person or other animal to Rabies in the past 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 may be performed.
I understand that euthanasia is the act of ending the life of an animal to prevent unnecessary suffering.
CANCELLATION POLICY: Kindest Farewell must be notified no later than 2 hours prior to your scheduled appointment to avoid a cancellation/rescheduling fee up to XXX.
RELEASE & CERTIFICATION: I agree to release and indemnify Kindest Farwell, the veterinarian and their owners, members, officers, directors, agents and employees from any claim, liability, cost or expense resulting from their reliance on services of other performance consistent with the directions, declarations, representations, authorizations and agreements herein. I agree that the liability Kindest Farewell, the veterinarian, and their owners, members, officers, directors, agents and employees, including without limitations for negligent acts (of itself or its agents or employees), is limited to a refund of the cremation and/or house call fees paid by me. I warrant that all representations and statements contained in this form are true and correct. I have read and understood all pages of this document.
PET DISCLOSURE: I further represent and warrant that the animal described above has not bitten any person or other animal during the past ten (10) days, is not suffering from Rabies and has not been exposed to other animals suffering from Rabies.
ACKNOWLEDGEMENT: To the best of my knowledge, the information I have provided is accurate and complete. 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 understood this form in its entirety.
FINAL DISPOSITION INSTRUCTIONS: I request to have the final disposition of my animal’s remains to be the following:
• I request my animal’s remains to be privately cremated and the ashes returned to me
• I request communal cremation with ashes not returned to me
• I request my animal’s remains be released to me
• I request the pet’s remains be held for at least 72 hours, after which time Kindest Farewell is authorized to dispose of the remains in accordance with company policy and charges
