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.

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

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. *

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