Owner's Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

(if different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sex *

Female

Male

Spayed/Neutered

Yes

No

Aftercare Wishes *

I, owner/agent, release the above-named animal to Hale to Heaven LLC for:

Group Cremation - I do NOT want my pet's ashes returned

Private Cremation - I would like my pet's ashes returned

Home Burial - I elect to keep my pet for burial in a lawful manner

I will make my own arrangements for aftercare/cremation

Would you like a clay paw print (one paw print at no charge)? *

Yes

No

Would you like a clipping of fur (no charge)? *

Yes

No