I, the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above, and that I give Blue Door Veterinary Services full and complete authority to humanely euthanatize and dispose of said animal in the manner we have discussed (communal or private cremation).

I acknowledge that the doctor has met with me personally and discussed the euthanasia of my animal. I also certify that to the best of my knowledge the said animal has not bitten any person or animal during the last fifteen (15) days, and has not been exposed to rabies. I further understand that I assume financial responsibility for all services rendered.

Again, by signing this form I am giving permission to humanely end this animal’s life, and I have the authority to execute this consent.