Name of Pet *

Kind of Pet *

Dog
Cat
Other

Age

Breed

Weight

Gender *

Male
Female

Owner's Name *

Address *

Address Line 1

City

State

Zip Code

Phone *

Best phone number to reach you

Email *

Email

Confirm Email

How did you learn about our service?

Your name, if different from the owner (Authorizing Agent)

Arrangement Type:

Immediate Need – My pet has died

Date of Death

Pre-Need

I am making arrangements prior to my pet's death.

It is important that you understand the cremation process. Cremation is an irreversible and final process. Please call our office at 704-664-5484 to clarify any questions you may have prior to submitting this form. This form authorizes the Private Cremation of your pet by Pet Pilgrimage Pet Crematory and Memorials. An indestructible identification tag accompanies your pet throughout the private cremation process. This system unconditionally guarantees that the cremated remains you receive are those of your pet. We strive to have the private cremation process completed within 24-48 hours. (Note: If you have not picked up your pet's cremated remains within 90 days, Pet Pilgrimage will scatter the cremated remains in a dignified manner.)

Items such as play toys, blankets and beds can be included in the cremation process. Please identify the items you would like to include or notify Pet Pilgrimage before the service.

I agree to release and indemnify the veterinarian, the funeral home, the crematory, their officers, directors, agents and employees, from any claim, liability, cost or expense resulting from their reliance on or performance consistent with the directions, declarations, representations, authorizations and agreements herein. I agree that the Veterinarian's , Funeral Home's and Crematory's liability for negligent acts (of itself or its agents or employees) is limited to a refund of the cremation fees paid by me. I warrant that all representations and statements contained in this form are true and correct. I have read and understand all the information herein.

By completing the information fields in this form, I represent that I am the Owner or an Agent of the Owner ("Authorizing Agent), and I have the right to authorize the cremation of the Pet's remains. I have read and understand all required Pet Disclosures as listed in this form.

Payment Information

Cremation fee – $195

Transportation – Transportation is available for a minimal fee. Please call our office for a quote, or payment can be made separately.

Urn – The cremation fee includes a hand-carved wood urn. Additional urn options can be purchased separately.

Plaque – Please call our office for a quote, or payment can be made separately.

You have the option of making your payment online, by phone or at our facility.

Please call us you if you have any questions: 704-664-5484.

Please choose on of the following options *

I prefer to pay by phone or at one of our facilities
I prefer to pay online

Pet Release/Cremation Authorization

Payment Information