Frozen Semen Release, Transfer, Disposal Form

Frozen Semen Release-Transfer-Disposal

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

I give permission for the actions regarding the frozen semen specified below to proceed. (please check all that apply):*

Use for insemination at Subzero Canine reproduction

Release semen for insemination at another facility

Transfer of ownership

Transfer of storage location

Semen disposal

Registered Name of Dog Semen Stored*

Call Name

DNA Profile Number*

Registration Number:*

Breed*

Number of breeding units to be released/transferred/used/disposed*

Name(s) of the new semen owner(s)

Breeding Unit 1

Collection Date

(If this information is not immediately available or unknown, you can leave this section blank and obtain after speaking with Subzero.)

Number of vials/straws

Cane Number ID

Post Thaw %

Breeding Unit Dose

Breeding Unit 2

Collection Date

Number of vials/straws

Cane Number ID

Post Thaw %

Breeding Unit Dose

Breeding Unit 3

Collection Date

Number of vials/straws

Cane Number ID

Post Thaw %

Breeding Unit Dose

BITCH INFORMATION

Registered Name

Call Name

Reg #

Breed

Owner

First Last

Phone

Complete if for Shipment and/or Transfer

Facility Name

(Only to be completed if shipping frozen semen.)

Facility Phone

Facility Email

Facility Address

Street Address Address Line 2 City State ZIP Code

NEW SEMEN OWNER/BITCH OWNER AUTHORIZED TO USE SEMEN LISTED ABOVE

Name(s)

Phone

Address

Street Address Address Line 2 City State ZIP Code

I Authorize the above Transaction and Certify I am the Legal Owner of the Frozen Semen listed above.

Signature

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

This field is hidden when viewing the form

Date of Authorization

I'm Not a Robot