Euthanasia Consent

Owner/Agent:*

First Name

Last Name

Patient Name:*

Patient Species:*

I, the undersigned, certify that I am the owner (or duly authorized agent) of the pet described above, that I do hereby give AAVEC, LLC, and the attending doctor of the patient specified above, his or her agents and representatives, full and complete authority to euthanize and dispose of said animal in a humane manner. I release the doctor or agents or representatives from any and all liability for euthanasia of said animal. I do also certify that, to the best of my knowledge, said animal has not bitten any person or other animal during the last fifteen (15) days, and has not been exposed to the Rabies virus. If I do not take my pet's remains home today or I choose the "UNDECIDED - HOLD" option below, I authorize AAVEC, LLC to send my pet's remains for group cremation after fourteen (14) calendar days from today.*

I agree.

Signature of Patient/Responsible Party:*

[clear]

Use your mouse or finger to draw your signature above

Today's Date:*

:

CREMATION SERVICES AVAILABLE:

AAVEC's cremation services are provided by: Agape Pet Services | 19712 Shepherdstown Pike | Boonsboro, MD 21713 | (301) 432-0431

GROUP CREMATION: Your pet is cremated together with other deceased patients and the remains are not returned to you. These ashes are scattered in a serene, wooded area on the crematory property in rural Boonsboro, MD.

What you will receive: within 14-16 business days, you will receive a clay paw print mailed to the address you provide below via USPS Priority Express.

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PRIVATE CREMATION: Your pet is cremated alone and his/her ashes are returned to you. For your peace of mind, a metal medallion with a unique serial ID number goes with your pet from our hospital all the way through the cremation process, and will be included with the remains in a cherrywood box urn.

What you will receive: (1) your pet's ashes in cherrywood box urn; (2) one clay paw print. These will be mailed via USPS Priority Express to the address you indicate below, and an adult's signature will be required upon delivery.

PLEASE PROVIDE YOUR PREFERRED EMAIL ADDRESS BELOW TO ENSURE THAT THE PET LOSS CENTER CAN SEND YOU TRACKING INFORMATION FOR THE DELIVERY OF YOUR PET'S ASHES/MEMORIAL ITEMS.

The owner/agent has elected the following final arrangements (PLEASE SELECT ONE OPTION FROM THE DROPDOWN BOX BELOW):*

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HUMANE EUTHANASIA INFORMATION & CONSENT

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HUMANE EUTHANASIA INFORMATION & CONSENT

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