Aquamation Authorization Form - 3 Trusted Simple Steps

Name of Pet *

Today’s Date *

Date of Death

Pet Status Pre-Planning or Not Yet Deceased

Type of Pet & Breed *

Gender *

Age *

Weight *

Color *

Nameplate Engraving

First Name *

Last Name *

Phone Number *

Owner’s Email Address *

Street Address *

City *

Zip Code *

1. Aquamation Authorization: The Owner or Legal Representative hereby authorizes Gentle Pet Crossing to arrange the aquamation of the remains of the Pet at their facility. In providing this authorization, the undersigned represents that he/she is the Owner or the Legal Representative of the Owner and has the full right and authority to arrange the aquamation and disposition of the remains.

2. Aquamation Process: The undersigned acknowledges that due to the nature of the aquamation process, any material on the remains of the Pet, such as collars, tags, etc., will be destroyed if not removed. Accordingly, the undersigned understands it will be removed and disposed or donated by Gentle Pet Crossing.

Owner or the Legal Representative of the Initial *

3. Type of aquamation *

4. Would you like a paw print *

5. How did you hear about us? *

Deliver the aquamated remains to ($100-$200 fee)

Release the aquamated remains to

Mail aquamated remains to ($50-$125 USPS fee)

If not picked up within thirty (30) days of the date of aquamation, Gentle Pet Crossing may dispose of the aquamated remains in any lawful manner.

Certification: The undersigned certifies the accuracy of all information on this Authorization and will indemnify and hold harmless Gentle Pet Crossing, their owners, employer and agents from any liability, cost, expenses, or claims resulting from this authorization and release thereon.

Owner or the Legal Representative *

Euthanasia Service performed by Doctor

Pets Animal Clinic Information

Clinic Name

Clinic Phone

Clinic Email Address

Clinic Full Address

Specialty Clinics or ER’s recently Visited

Visited Clinic Name

Visited Clinic Phone

Visited Clinic Email Address

Visited Clinic Full Address

Electronic Signature

Certification: The undersigned certifies the accuracy of all information on this Authorization and will indemnify and hold harmless Gentle Pet Crossing, their owners, employer and agents from any liability, cost, expenses, or claims resulting from this authorization and release thereon.

Type Full Name to Sign (Owner or Legal Representative) *

Gentle Pet Crossing servicing the Treasure Coast to Miami-Dade

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Pets Animal Clinic Information

Specialty Clinics or ER’s recently Visited

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