I, the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above, that I do hereby give the doctors of Veterinary Medical Center of Fort Mill permission to euthanize and dispose of said animal in whatever humane manner the doctors of Veterinary Medical Center of Fort Mill, their agents, servants or representatives deem appropriate. I also release the doctors, Veterinary Medical Center of Fort Mill, their agents, servants, and representative from any and all liability for so euthanizing and disposing of said animal.

I do also certify that to the best of my knowledge the said animal has not bitten any person or animal during the last fifteen (15) days and has not been exposed to rabies.