Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

My pet is a: *

intact female

spayed female

intact male

neutered male

I certify that I am the owner or authorized agent of the owner, for the above-named animal. In being the owner/agent for this animal, I do hereby give Yonder Care full and complete authority to perform euthanasia services. Arrangements for aftercare will be based on the wishes of the owner/agent and documented below. I release the above-named animal to Yonder Care for: *

Euthanasia - humane termination of life. $285 during regular business hours, $360 after hours/emergency.

Aftercare/ Body Disposition Request *

I choose to retain my pet's body and regulations have been discussed. For home burial, I agree to bury my pet's body in such a manner that will prevent consumption by wildlife.

I choose communal cremation at $125 additional charge (ashes will not be returned).

I choose private cremation at $330 for dogs ≥ 50 lbs or $300 for cats and dogs < 50lbs. See included urn options at the bottom of the page, then write which urn you want in the "other special requests" text box below.

I would like an ink paw print keepsake (no additional charge).

I would like a framed clay paw print with with engraved name plate for an additional $65

To the best of my knowledge, the information I have provided on this form is true. I do also certify that this animal has not bitten, seriously scratched, or exposed anyone to rabies within the past 10 days. Fees for these services have been explained to me and will be collected prior to services rendered. *

By checking this box, I agree to the terms and conditions outlined above.