Euthanasia Consent Form "*" indicates required fields Name* First Last Pet's name* Consent*I, the undersigned, hereby state that I am the legal owner or legally authorized representative of the legal owner of the above listed pet and authorized to make all medical decisions regarding this pet. I have declined any further care for the above pet and am hereby authorizing Animal Medical Center of Mid-America to euthanize the above listed pet. I agree to have Animal Medical Center of Mid-America choose a euthanasia protocol at their sole and exclusive discretion; and I do hereby forever release Animal Medical Center of Mid-America and its agents, servants or representatives from any and all liability for so euthanizing the above listed pet. I do also certify that the above listed pet has not been exposed to rabies and has not bitten any person or animal in the last 10 days. I have read and understand this consent.I hereby make my wishes regarding the care of my pet's remains* I have decided to take my pet's remains with me today, to seek private burial. I am solely responsible for following all municipal ordinances regarding the care of my pet's remains. I have decided to allow my pet's remains to be cremated communally, and hereby acknowledge that I do not wish for the cremains to be returned to me. I have decided that I would like to have my pet's remains cremated individually, and thus I have elected to use the services of a private crematory and to have my pet’s cremains returned to me once the cremation is carried out. I realize that a private crematory conducts this service, and while every attempt is made to ensure that this service is carried out in accordance to my wishes, any errors or omissions on the part of the crematory are solely the responsibility of the crematory. I agree to hold HSMO / AMCMA harmless should my wishes not be carried out. Signature*By typing your name here and submitting you agree to the terms above. PhoneThis field is for validation purposes and should be left unchanged.