Eternal Waters Aquamation - Authorization for Aquamation

Pet Parent Name:

Address: *

Email: *

NOTE: We do not share email or other contact information.

Phone Number: *

Preferred Contact Method:

Phone
Text
Email

This is the primary method we will use to contact you when your pet's ashes and/or keepsakes are ready to return home. We do not share your contact information.

Pet Name: *

Pet Last Name (If different from above):

This is the last name we will use on the aquamation certificate and name labels.

Pet Type: *

Male/Female: *

Pet Breed and Color:

Pet Weight:

Pet Age:

Service Type: *

Individual (Ashes returned)
Communal (Ashes NOT returned; scattered on private property)

Urn Choice:

Wood Urn
Scatter Tube (I plan to scatter my pet's ashes or purchase my own urn)
NOTE: Scatter Tube not available for Communal Service

Keepsakes:

Clay Paw Print
Fur Clipping

Pet Status: *

My pet passed away at home
My pet is being held at a veterinary hospital
Preplanning: Euthanasia appointment scheduled
Preplanning: Please keep arrangements on file

Pet Pick Up or Drop Off: *

I will bring my pet to Eternal Waters
Please pick up my pet at the veterinary hospital listed below
Please contact me to discuss options

Veterinary Hospital Where My Pet is Being Held:

Euthanasia Appointment Date/Time or Date Pet Passed Away:

Special Instructions:

By submitting this form, I indicate that I am the authorized agent or the owner of the pet identified on this form. I have completely read and understand this form and all statements contained within are true and correct. Further, I agree to hereby release Eternal Waters Aquamation, their agents and representatives, from all liability for this pet.

Pet Owner's Authorization for Aquamation

Pet Owner's
Authorization for Aquamation