Pet Cremation Authorization Form

Owner & Deceased Pet Information

First Name

Last Name

Street Address

City

State

Zip code

Phone

Pet's Name

Pet Breed

Date of Death

Pet Weight

Pet Color

Deceased Pet Pick Up / Drop Off Information

Name of Person Droppng Off Pet

Pet Pick Up Address

Pet Pick Up Location Phone

Pet Pick Up Location Contact

Authorization, Unclaimed Remains, and Release

Authorization: I certify that I am the owner, or authorized agent of the owner, of the pet described above and that I am 18 years of age or older. I understand that water cremation is an irreversible process and I hereby authorize the following method of water cremation:

Water Cremation Selection

Communal cremation where multiple pets are cremated without separation of pets. Cremated remains are not available for return to the owner.

Individual compartment cremation where each pet is isolated in their own stainless steel compartment, separated from other pets, during the water cremation cycle.

Private Cremation where only one pet is present in the cremation vessel during the water cremation process.

Unclaimed Remains: I understand if my pet's cremated remains are unclaimed for 90 days after notification of cremated remains availability, the Crematory reserves the right to dispose of the cremated remains in a dignified manner.

Release and Certification: I agree to release and indemnify the Crematory, agents and employees, from any claim, liability, cost or expense resulting from their reliance on or performance consistent with the directions, authorizations and agreements herein. I agree that the Crematory’s liability for negligent acts (of itself, agents, or employees) is limited to a refund of the cremation fees paid for this pet. I warrant that all representations and statements contained in this form are true and correct. I have read, understand, and agree with this document.

Cremation Authorization Signature

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