Frozen Semen Destruction Consent and Agreement Complete this form to agree to and consent to the destruction of a stated number of straws containing frozen semen for the purpose of testing and reporting results or avoidance of future storage expense. Date Completing the Form* MM slash DD slash YYYY Stallion's Registered Name* Please list the recognized name of the stallion from which the frozen semen originates.Expected/estimated number of straws in storage.* Please note the number of straws that you estimate are in storage. If a significant disparity exists, you will be notified. Name of Legal Owner of Frozen Semen* First Last Phone Number of Legal Owner of Frozen Semen*Email of Legal Owner* Number of Straws to be Destroyed* Please note "ALL" if you are requesting all straws to be destroyed. If a specific number is to be destroyed for the purpose of testing, please list that number agreed upon specifically for this purpose. Person signing is Owner or Legal Agent*Legal OwnerLegal AgentPlease press and highlight the appropriate choice - Legal OWNER of the frozen semen in storage OR if you are the Legal AGENT of the owner, acting on their behalf. As Legal Agent, your name must be referenced in the records of the stored semen for cross reference. I attest, agree and consent* Attest, Agree and Consent to complete and final destruction of frozen semen originating from the previously noted and listed stallion.I attest that I have the full and legal authority to agree, consent to and order the destruction of the stated number of frozen semen straws originating from the above listed stallion, for the purpose of testing OR avoidance of future cost of storage. I understand that once removed from the protective environment of liquid nitrogen for more than 2 seconds, the semen will be considered destroyed unless used for immediate insemination or testing. I hereby agree and consent to the previously noted procedure above - testing or destruction. Printed name of person signing this form* First Last Signature of Legal Owner or Legal Agent* Reset signature Signature locked. Reset to sign again CAPTCHA Δ
