VMD 511: Animal Welfare, Ethics and Jurisprudence (2+0)

REQUEST FORM FOR EUTHANASIA

Owner's Name………………………

S/o………………………….

R/o………………

Animal………………….

Breed………………

Sex……….

Age………..

Colour and markings………………………

I, the undersigned, do hereby certify that I am the owner (or duly authorized agent of the owner ) of the animal described above, that I do hereby given to Veterinary Surgeons/his representative ………………………………. Complete authority to put to sleep the animal in whatever manner the said Veterinary Surgeon / his representative shall deem fit and I do hereby undertake to put the animal to sleep at my sole risk and by by these presents forever absolve the said Veterinary Practitionerlhis representative from any and all liabilities for so putting to sleep the said animal.

I do also certify that the said animal has not bitten any person or animal during the last fifteen days and to the best of my knowledge has not been exposed to rabies.

Date………………                                                                      

Signature of the owner