Authorization for Aquamation

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Pet's Name

Breed, Color, Age

Gender, Weight

Pet's Status

Pet Disclosures

Does your pet have medical implants (orthopedic pins, plates, screws, pacemakers, clips, etc?

Pet Disclosures

Did your pet have any of the following viruses/diseases?

Pet Disclosures

I represent and warrant that this animal has not bitten any person or animal in the last ten (10 days)

Deceased Date

YYYY

Pet Pickup

Authorization: This Authorization Form is required to be completed and signed prior to the final disposition of your pet. Aquamation IS AN IRREVERSIBLE AND FINAL PROCESS. It is important that you understand the aquamation process and the different options available prior to initialing and signing below. Please ask us any questions about the process you may have.

I/We represent that I/We have the right to authorize the aquamation of the Pet’s remains and warrant that I/We are the Owner or an Agent of the Owner (“Authorizing Agent”). I/We have read and initialed all required Pet Disclosures as listed. I/We have read and understand the description of the different available aquamation processes described below, including the final disposition/return of aquamated remains; by initialing below, I/We authorize the following:

Select an option:

Individual Cremation: I/We shall receive my pet's remains within 1-2 weeks (as defined below).

Communal Aquamation: I elect NOT to receive my pet's ashes to me.

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