Euthanasia Authorization

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Pet's Name(Required)

Species:(Required)

Sex:(Required)

Color:(Required)

Markings:(Required)

Age:(Required)

After-Care Options(Required)

Return to owner for burial

Cremated with no return to owner

Cremated with ashes returned to owner

Memorial Options

Clay Paw Print ($25 Charge)

Ink Paw Print (No Charge)

I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described that I do hereby give the doctors of York Veterinary Services permission to euthanize and dispose of said animal in whatever manner the said doctors of York Veterinary Services, their agents, servants, or representatives deem fit. I also release the doctors, York Veterinary Services, their agents, servants, and representatives from any and all liability for so euthanizing and disposing of said animal. I do also certify that to the best of my knowledge the said animal has not bitten any person or animal during the last ten (10) days and has not been exposed to rabies.(Required)

34472

Euthanasia Authorization

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