I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal described above. I do hereby give Cleary Lake Veterinary Hospital, its agents and representatives full and complete authority to humanely euthanize the said animal. I also release Cleary Lake Veterinary Hospital, its agents and representatives from any and all liability for so euthanizing the said animal.

I, the undersigned understand that it is my responsibility to dispose of the above animal's body in an appropriate and legal way. I also understand that the ingestion of any portion of the body by wildlife or domestic animals can cause poisoning that could lead to death. It is my responsibility to ensure that no animal gains access to the body before disposal.