I, the undersigned, do hereby certify that I am the owner, or duly authorized agent for the owner, of the animal described above and that I do hereby give Georgetown Veterinary Hospital, its veterinarians, agents and/or representatives full and complete authority to humanely euthanize said animal above.
I do hereby and by the presents forever release the said doctor, their agents, or representatives from any and all liability arising from the euthanasia of said animal.
I do also certify that the said animal has not bitten any person during the last ten (10) days and to the best of my knowledge has not been exposed to rabies.
I the owner/agent accept full financial responsibility for all charges incurred for this procedure. I understand that payment is due in full prior to euthanasia unless prior arrangements have been made with Georgetown Veterinary Hospital management.