Frozen Semen Transfer Form

This completed form is required by law in order for us to provide service. This information is kept secure, private and will not be shared with any 3rd party without your expressed consent.

Todays Date?*
MM slash DD slash YYYY
Agent Information (optional)
Are you an agent or representative of the owner?*
- Yes
- No
If you indicate yes, please complete the following sections. Otherwise please skip to the owner section.
Agent Name
First Last
Agent Mobile Number
Agent Email Address
Who do we communicate with?
- Agent
- Owner
Owner Information (required)
Owner Name*
First Last
Owner Mailing Address (if different, otherwise leave blank)
Street Address Address Line 2 City State ZIP Code
Owner Mobile Phone Number*
Owner Email
Frozen Semen Information
Stallion Name*
Stallion Name
Breed (please fill in)*
Number of Doses Stored*
Number of Straws (if known)
Name of person to release custody to.*
First Last
Mobile phone number of person to release.
Release Statement*
I hereby release all interest in, the referenced above frozen semen stored at Rogue Equine Hospital, in its entirety. Before release, I understand all debts regarding storage and transfer fees will be settled in advance. In addition, I understand Rogue Equine Hospital Inc., its principals and employees will be held harmless in regards to actual status of the above referenced frozen semen. The semen will be physically, and/or in name, be transferred "AS IS" and without warranty. By ticking this box and signing below, I indicate that I am the rightful owner of the above referenced frozen semen and have full authority to execute this release and transaction.
Signature of person (owner) releasing frozen semen*
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Name
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Frozen Semen Transfer Form

Frozen Semen Transfer Form

Agent Information (optional)

Owner Information (required)

Frozen Semen Information