PETS

Please complete the form and submit to be contacted by a member of our staff. You will also be given the option to print a copy for your records. 

The undersigned authorizes Good Shepherd, in accordance with and subject to Federal, State, and Good Shepherd rules and regulations, to cremate the remains of:

(Animal First Name)

(Family Last Name)

Dog

Cat

Other

Has your pet passed or are you pre planning? Passed  Pre Planning

Select Return Type

Cremation with return

Cremation without return

I have the right to authorize this cremation and the disposition of the cremated remains.  I understand that due to the nature of the cremation process any valuable material will either be destroyed or not recoverable.  Any personal possessions accordingly have been either removed or may be destroyed.  I further agree that I will indemnify and hold harmless Good Shepherd, their officers, and employees from any liability, cost, expenses or claims resulting from this authorization and subsequent disposition.

First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
Email:

Who is your regular veterinarian?
Name:
Street Address:
City:
State:
Zip Code:
Phone Number:

Would you like to be notified by Good Shepherd Pet Services regarding the status of your pet?

Yes

No

AUTHORIZATION

This Authorization Form is required to be completed and signed prior to the final disposition of your 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. We want you to fully understand the information provided in the Authorization Form, so we will be pleased to answer any questions you may have. I/We represent that I/We have the right to authorize the cremation of the Pet’s remains and warrant the I/We are the Owner or an Agent of the Owner (’Authorizing Agent’). I/We have read and initialed all required Pet Disclosures as listed in the Terms and Conditions (ask your vet for a copy). I/We have read and understand the description of the different available cremation processes described in the Terms and Conditions including the final disposition/return of the cremated remains; by initialing below, I/We authorize the following: I/We shall receive my pet’s cremated remains. the Crematory shall scatter all cremated remains and I /We will not receive any cremated remains. Initials RELEASE AND CERTIFICATION I/We agree to release and indemnify the Veterinarian, the Crematory, their officers, directors, agents and employees, from and claim, liability, cost or expense resulting from their reliance on or performance consistent with the directions, declarations, representations, authorizations and agreements herein. I/We agree the Veterinarian and Crematory’s liability for negligent acts (of itself or its agents or employees) is limited to a refund of the cremation fees paid by me/us. I/We warrant that all representations and statements contained in this form are true and correct. I/We have read and understood all pages if this document. By signing you agree to the Terms and Conditions of Good Shepherd Pet Services, Inc. This authorization for cremation and disposition was executed at, this day of    . Owner/Authorizing Agent Name:

Signature