DOWNLOAD FORM Date MM slash DD slash YYYY Owner's Name First Last Address Street Address City State / Province / Region ZIP / Postal Code PhoneAnimal's NameUntitled Canine Feline BreedMIXUntitled First Choice Second Choice Third Choice I CERTIFY THAT I AM THE OWNER OF (OR PERSON RESPONSIBLE FOR) THE ANIMAL DESCRIBED ABOVE. I GIVE THE VETERINARIAN AND HIS/HER ASSISTANTS COMPLETE AUTHORITY TO EUTHANIZE THIS ANIMAL IN WHATEVER MANNER THEY RECOMMENDED. I UNDERSTAND THAT THE ANIMAL WILL BE TREATED HUMANELY. I RELEASE THE DOCTOR AND HIS ASSISTANTS FOR ANY LIABILITY FOR EUTHANIZING THIS ANIMAL AND RELINQUISH ALL OWNERSHIP RIGHTS AND RESPONSABILITES OF THE ANIMAL DESCRIBED ABOVE TO HIALEAH ANIMAL CLINIC.I ALSO CERITFY THAT THIS ANIMAL HAS NOT BITTEN ANY PERSON OR ANIMAL IN THE PAST 15 DAYS AND TO BEST KNOWLEDGE HAS NOT BEEN EXPOSED TO RABIES.Owner's SignaturePhoneThis field is for validation purposes and should be left unchanged.
