Request to Perform Humane Euthanasia

Animal Information

I, the undersigned, certify that I am the owner (or an authorized agent for the owner) of the above-stated animal, and I consent to, and order euthanasia to be performed on the said animal. To the best of my knowledge, and belief, this animal has not bitten any person or animals during the past 10 days and has not been exposed to rabies. I give Parliament Animal Hospital’s veterinarian full and complete authority to euthanize the said animal in a humane manner and in accordance with the rules and regulations of the establishment. I forever release the doctor or representatives from any and all liability of the said euthanasia.

Furthermore, I authorize the attending veterinarian to take care of the remains in the following manner (please check one of the following).

I will take care of the remains.Communal cremation (ashes not returned)Individual cremation (ashes returned)