• I certify that I am the owner of the above-described animal. I have brought my pet to Dr. Burcham at Mariposa Veterinary Wellness Center for advice on attempting to decrease its aggressiveness.

    I understand that aggression by animals can cause not only damage to property but also personal injury, including fatal injury, to other animals, people, and to me. I also understand that treatment for aggressive behavior in animals is not an exact science, and it is not possible to ensure that my pet will not cause harm in the future.

    I understand that the only way to ensure that my pet will not cause harm, injury and/or property damage in the future is to euthanize it now. I fully understand that “to euthanize” means the deliberate ending of life of my pet.

    I further fully understand that if I do not euthanize my pet now, it will be my personal responsibility to take all appropriate precautions and steps to prevent my pet from causing harm, injury and/or property damage. These precautions may include, but are not limited to, informing persons near my pet of its aggressive behavior, keeping it on a leash and muzzled or with a head collar, and/or keeping it restrained at all times behind secure doors, gates, and/or fencing. I also understand that it is and will be my personal responsibility fully to be aware of and to comply with all federal, state and local laws, ordinances and regulations concerning aggressive animals.

    I understand that should I choose not to euthanize my pet now and it causes harm, injury and/or property damage in the future, I may be held personally liable for such harm, injury and/or property damage. I also understand that such liability could be significant. I further understand that even if I have insurance my insurance might exclude aggressive animals and/or might not be adequate to cover a claim for harm, injury and/or damage caused by my pet.

    I hereby certify that I have completely read and understand the above and that I am signing this authorization with the full appreciation and understanding that the treatment of my pet may not eliminate nor reduce its aggressive behavior. I also certify that no assurances whatever have been made to me by Dr. Burcham nor any person as Mariposa Veterinary Wellness Center that any of the treatment proposed or to be done for me will eliminate or reduce its aggressive behavior or even if it might that such elimination or reduction would ever be permanent.

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