I, the undersigned, do hereby certify that I am the owner or authorized agent for the owner of the animal described above, and that I do hereby give the doctors of Veterinary Specialists of the Rockies permission to euthanize and dispose of said animal in whatever humane manner the doctors, their agents, or representatives deem appropriate. I also release the doctors, Veterinary Specialists of the Rockies, their agents and representatives from any and all liability for so euthanizing and disposing of said animal.

I do also certify that, to the best of my knowledge, this pet has not bitten any person or animal during the last fifteen (15) days and has not been exposed to rabies. I have been informed that if I cannot certify these statements, state law and public health authorities may require further testing for rabies be performed at a diagnostic laboratory and this may be done at my expense.

I acknowledge that if I have not picked up my pet's remains within 6 months, Veterinary Specialists of the Rockies has permission to scatter my pet's remains. We are very sorry for your loss.