Note:
As owner, or duly authorized agent of the owner, of the animal described here on, I hereby consent to, and order, euthanasia to be performed on same for humane reasons. I further authorize the attending veterinarian to dispose of the remains in accordance with hospital policy. If I choose cremation, I am aware that there is an extra charge to do so. To the best of my knowledge and belief this animal has not bitten any person during the fifteen days preceding this date.
