I authorize the Private Cremation of my pet. I have read the authorization on the reverse side of this form and agree with the terms of service. Your signature also authorizes the credit card payment.
Courier to vet office available for additional charge of $15.00 *Note: Collars, blankets or any other personal items cannot be returned. **Note: Specify type of urn you would like on the line provided above.
I have authorized Dream Land Pet Memorial Center, LLC (DLPMC) and/or one of its affiliated companies to care for my pet as indicated on the reverse side of this page.
I understand that this will be a private cremation that will include my pet having a unique identification number and tag that will accompany my pet throughout the removal and cremation process to insure the integrity of the private cremation.
I understand that DLPMC will hold the cremated remains for no less than thirty (30) days, during which time I or someone on my behalf will retrieve them or arrange for their return. If no arrangements are made for the final disposition, release or shipment of the cremated remains, or if DLPMC is unable to contact me using the information I have provided,
I agree that DLPMC shall have the right to send the cremated remains to the address listed on the reverse side of this page at the expense of the owner or DLPMC reserves the right to scatter my pet’s ashes in a respectful manner.
I hereby release and shall indemnify and hold harmless DLPMC and its successors, assigns, sister, parent and subsidiary companies and their respective officers, directors, shareholders, employees and agents from any and all liability, claims, suits and damages arising from or relating to the handling, cremation and release of my pet.
I understand and agree that DLPMC’s liability arising under this agreement shall be limited to and shall not exceed the amount paid by me to DLPMC and, further, that DLPMC shall not be responsible for any indirect, incidental, special or consequential damages I may suffer or claim, including without limitation damages for emotional distress.
I acknowledge that DLPMC shall not be liable for any loss or delay resulting from any events outside of its control, including without limitation acts of God, fire, national disaster, terrorism, war or labor stoppage.
I agree that this authorization form shall be governed by the laws of Cobb County Georgia. In the event DLPMC or its representatives have to initiate a collections action against me,
I agree to pay the costs of collection, including attorneys’ fees.