Frozen Semen Release &/or Transfer

Frozen Semen Release &/or Transfer
As owner of the below identified semen, I,     authorize the representatives of Olney-Sandy Spring Veterinary Hospital to release the semen for the purpose indicated

Dog’s registered name
Dog’s call name     Dog’s registration number
Semen to be released
Number of breeding units*
Number of StrawsQuantity of straws at our discretion
Number of Straws
Collection date(s)
(Optional)
Disposition Reason

Transfer ownership of the semenFor breeding purposesChanging storage locationTest thaw
For purposes of ownership transfer or breeding - Bitch Owner or New Owner’s Information
Name*
Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If for breeding purposes
Bitch’s registered name
Bitch’s call name
Bitch’s registration number
Is the insemination being performed at our hospital?

YesNo
Location of where the semen will be transferred
Facility Name
Dr
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I have confirmed that the receiving hospital has storage facilities for frozen semen. Ship at your convenienceI have confirmed that the receiving hospital has storage facilities for frozen semen and the bitch is in heat. Please ship as soon as possible.The veterinarian does not store semen, but the bitch is in heat. Please ship onThis form is for future breeding arrangements. Please store semen until notified.
Shipping Date

MonthDayYear
Date
** Both forms (Frozen Semen Release / Transfer and Frozen Semen Credit Card Authorization) must be completed in full before the semen can be shipped. Advanced notice of 3-5 full business days (Mon.–Fri.) is required to prepare the shipment.
Printed Name*
Phone Number*
Email*
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Frozen Semen Release &/or Transfer

Semen to be released

For purposes of ownership transfer or breeding - Bitch Owner or New Owner’s Information

If for breeding purposes

Location of where the semen will be transferred