Cremation Authorization Form | www.cremation-by-water.com

Pet Cremation Authorization Form

Owner & Deceased Pet Information

First Name

Last Name

Address

City

State

Zip

Phone

Pet's Name

Pet Breed

Date of Death

Pet Weight

Pet Color

Deceased Pet Pick Up / Drop Off Information

Name of Person Dropping Off Pet

Vet Office / Contact Name

Vet Office / Other Address

Vet Office / Other Phone

Authorization, Unclaimed Remains, and Release

Authorization: I certify that I am the owner, or authorized agent of the owner, of the pet described in Step 1 and that I am 18 years of age or older. I understand that water cremation is an irreversible process and I hereby authorize the following method of water cremation:

Water Cremation Selection

Communal Cremation where multiple pets are present in the cremation vessel without any form of separation. The comingled cremated remains are not available for return to the owners.

Partitioned Cremation where more than one pet is present in the cremation vessel, each pet is separated within the vessel by a partition, and each pet's individual cremated remains are available for return to the owner.

Private Cremation where only one pet is present in the cremation vessel during the cremation process and the pet's cremated remains are available for return to the owner.

Private Cremation With Witness Option where the persons identified on the Cremation Witness Acknowledgement Form may be present prior to and during the first 15 minutes of the cremation process where only one pet is present in the cremation vessel during the cremation process and the pet's cremated remains are available for return to the owner.

Unclaimed Remains: I understand if my pet's cremated remains are unclaimed for 30 days after notification of cremated remains availability, the Crematory reserves the right to dispose of the cremated remains in a dignified manner.

Release and Certification: I agree to release and indemnify the Crematory, agents and employees, from any claim, liability, cost or expense resulting from their reliance on or performance consistent with the directions, authorizations and agreements herein. I agree that the Crematory’s liability for negligent acts (of itself, agents, or employees) is limited to a refund of the cremation fees paid for this pet. I warrant that all representations and statements contained in this form are true and correct. I have read, understand, and agree with this document.

Cremation Authorization Signature