I, the undersigned, certify that I am the owner or authorized agent for the owner of the above described animal and I have the authority to execute this consent. I also certify that the animal has not bitten a person or animal in the past 10 days.
On this date, I do hereby give the doctors of Cheyenne West Animal Hospital complete authority to perform euthenasia of this animal, provide for final disposition of the remains, and I release them from any and all liability. I further understand that I assume financial responsibility for all services rendered.