Euthanasia Form

I am the owner (or duly authorized agent for the owner) of the animal described above.

I have discussed the reasons for euthanasia with a veterinarian and I am completely satisfied that humane euthanasia is the appropriate course of action. I consent to and order euthanasia (humane death) to be performed on this animal for humane reasons, releasing Pikes Peak Veterinary Clinic and its staff from any and all liability for performing this euthanasia.

To the best of my knowledge and belief this animal has not bitten any person during the ten days preceding this date, and is not under observation as required by the rabies law.