River Valley Pet Cremation Society Membership Form

Yes! I want to join the River Valley Pet Cremation Society and receive $50 off the Signature Cremation Package.

Simply fill out the online form below or use this button to download a copy of the form and email it to office@rivervalleypet.com. Your one-time $10 membership payment is due after you submit the form. The remaining $265 is due when cremation services are needed. You may prepay the full amount at any time.

Membership Form Download

Membership Form

Pet's Name:

Pet's Date Of Birth:

Pet's Gender:

Type of Pet/Breed:

Color:

Pet Owner's Name(s):

Cell Phone:

Email:

Address:

Home/Vet Clinic, if applicable (name, address, phone#)

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You may skip over the next three lines. Please read the text after these boxes, give your consent and signature, then SUBMIT THE FORM.

Pet's Date of Death:

Pet's Age at Time of Death:

New Field:

Received From:

Items to be Cremated with Pet:

Items to be returned to the owner

Date/Time Cremains Were Returned:

Returned To:

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Authorization: Cremation is an irreversible and final process. I represent that I have the right to authorize the cremation of the pet’s remains and warrant that I am the owner or an agent of the owner.

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Release and Certification: I agree to release and indemnify the crematory, agents and employees, from any claim, liability, cost or expense resulting from the reliance on or performance consistent with the directions, declarations, representations, authorizations and agreements herein. I agree that the 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 understood this document.

Return: I understand I must pick up the ashes within 30 days. After such time, River Valley Pet Cremation reserves the right to dispose of the ashes in a dignified manner when no provisions have been made.

Pet Disclosure: I further represent and warrant that our pet has not bitten any person or other animal during the past (10) days, is not suffering from rabies, and has not been exposed to other animals suffering from rabies.

I give my consent by electronic means to authorize cremation.

Signature (Full Legal Name) of Pet Owner or Authorized Representative:

After you submit this form, please make your $10 payment HERE. If you wish to pay the full amount of $275, you are welcome to do so.
One form per pet. One membership per pet.

Thank you!