Cremation Authorization

Today's Date *

Veterinarian Clinic / Hospital Name

If you are an individual, you do not fill in this section unless your pet is being euthanized by a veterinarian; in that case fill in the information about that veterinarian or veterinary clinic/hospital.

Veterinarian Clinic / Hospital Phone

If you are an individual, you do not fill in this section unless your pet is being euthanized by a veterinarian; in that case fill in the information about that veterinarian or veterinary clinic/hospital.

If you are filling out this form with euthanasia having been scheduled but not yet performed, please provide the date for euthanasia.

Date

Time

Veterinarian Clinic / Hospital Address

Address Line 1

Address Line 2

City

State

Zip Code

If you are an individual, you do not fill in this section unless your pet is being euthanized by a veterinarian; in that case fill in the information about that veterinarian or veterinary clinic/hospital.

Pets Name *

Type of Pet *

Dog, Cat, Parrot, Hamster, Snake, Horse, Pig, etc.

Breed

Color(s)

Gender *

Weight (approximate pounds - max 200lbs) *

Pet Owner's Name(s) *

(optional: Names of other family members)
Creating a list format is easiest:
--John Smith
--Katy Smith

Email Address of Pet Owner *

Home Address of Pet Owner

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number of Pet Owner *

All cremations include one Terra Cotta clay paw print, one ink print, and a fur clipping.

Additional Terra Cotta Clay Paw Print ($10)
Additional Ink Print ($20)
Additional Fur ($15)

Cremation Request - Private - Only one pet is present in the cremation chamber. The pet owner will receive the cremated remains of their pet and only their pet.

Urn Selection - Choice of urn - Blue Scattering Tube
Urn Selection - Choice of urn - Cedar Memorial Urn
No Cremains Returned

Custom Urn/Memorial Item (add item #s below):

Authorization

This Authorization Form is provided by you, the Pet Owner, or your authorized agent, (with either one being referred to as “You”) to Pets Remembered Cremation Service, LLC (referred to as “Pets Remembered”) regarding the pet described above. This Authorization Form is required to be completed and signed prior to cremation (the final disposition) of the pet. CREMATION IS AN IRREVERSIBLE AND FINAL PROCESS. It is important that You understand the cremation process and different options available prior to signing it. Pets Remembered wants You to fully understand the information provided in this Authorization Form, so please ask any questions You may have.

Representation: You represent that You have the right to authorize the cremation of the pet’s remains and warrant that You are the Pet Owner or an agent of the Pet Owner.

Release and Indemnification: You agree to release and indemnify Pets Remembered, and its agents and employees, from any claim, liability, cost, or expense, of any kind, resulting from Pets Remembered’s reliance on or performance consistent with the directions, declarations, representations, authorizations and agreements provided by this Authorization Form. You agree that Pets Remembered’s liability for negligent acts (of itself or its agents or employees) is limited to a refund of the cremation fees paid to Pets Remembered by You.

Return of Pet’s Ashes: You understand that You must pick up the pet’s ashes within thirty (30) days following the date of this authorization. After that date, Pets Remembered reserves the right to dispose of the pet’s ashes in a dignified manner when no other provisions for disposition of the pet’s ashes have been made by the signer of this Authorization Form.

Disclosure Regarding Pet: You further represent and warrant the pet: (a) has not bitten any person or other animal during the past ten (10) days; (b) does not have Rabies; (c) has not been exposed to other animals suffering from Rabies.

You warrant that your representations and statements contained in this Authorization Form are true and correct.

You agree that You have read and understand this Authorization Form.

By writing your name and clicking on the Submit button below, you are signing this Authorization Form.

Online Signature Authorization *

(Pet Owner or Authorized Agent)