Euthanasia and Aquamation Authorization Form

Name of Pet *

Today’s Date *

Date of Death *

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)

Electronic Signature

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

Euthanasia Service – Non-Refundable Policy

1. Non-Refundable Payment
All fees associated with euthanasia services are non-refundable. This includes, but is not limited to:

Euthanasia procedure fees
After-care service fees (cremation, communal or private, memorial items, etc.)
Consultation or appointment fees specifically for euthanasia services or quality of life assessments.

Once payment is made and/or the service has been initiated, no refunds will be issued.
2. Appointment Cancellations

Cancellations made at least 24 hours in advance may allow for rescheduling without additional fees.
Same-day cancellations or no-shows will result in forfeiture of the full euthanasia fee, as the appointment time is reserved exclusively for the client and cannot be filled on short notice.

3. Changes to After-Care Arrangements
Once after-care services (such as cremation) have been initiated, changes or cancellations are not possible. Fees for these services remain non-refundable.
4. Exceptions
Refunds may only be considered in cases of:

Administrative or billing errors made by the clinic
Duplicate charges
Should your loved one pass away 1 hour before the doctor has arrived

No exceptions will be made due to changes in the owner’s decision once services have begun.
5. Acknowledgment
By scheduling or paying for euthanasia services, the client acknowledges that they have read and understand this non-refundable policy and agree to its terms.

Electronic Signature

By agreeing these terms, I certifies that I am the owner (or authorized agent) of this pet. This pet has not been exposed to rabies and has not bitten any person or animal in the last 10 days. I give this veterinarian permission to compassionately euthanize my pet and release the veterinarian from all liability in performing this euthanasia. If not handling the remains myself, I do hereby convey the body to this veterinarian for gentle pet aquamation. I authorize group or private aquamation to be performed and release the veterinarian and aquamation center from all liability in performing the aquamation service.

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

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Electronic Signature

Pets Animal Clinic Information

Specialty Clinics or ER’s recently Visited

Euthanasia Service – Non-Refundable Policy

Electronic Signature

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