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 or animal during the last fifteen (15) 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 GVH management.