Savannah Animal Hospital and Hotel - Euthanasia Authorization

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Owner's Name: *
Address: *
City: *
State: *
Zip Code: *
Home Phone: *

Pet's Name: *
Date of Birth: *
Sex: *	Male: Female:
Breed: *
Description: *


Cremation Sevices:
Private:	Communal:
Relationship to the pet:
Legal Owner	Authorized Agent

I certify that I am the legal owner/duly authorized agent for the owner of the animal described above, and do hereby give Savannah Animal Hospital and any authorized agents, staff or representatives full and complete authority to euthanize and dispose of said animal in a humane manner. Unless otherwise agreed upon, disposition of the body of said animal is left to the judgment of the veterinarioan. I hereby forever release Savannah Animal Hospital and any authorized agents, staff or representatives from any and all liability for authanasia and disposition of said animal.

To the best of my knowledge, the animal described above has not bitten, scratched or otherwise potentially exposed any person or animal to rabies in the past ten (10) days. I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test must be performed.

I have read and understand this authorization. To the best of my knowledge, the information I have provided is true. I understand that my wishes may be carried out immediately upon my signing this agreement. Fees for these services have been explained to me.

Date: