PROFORMA OF CONSENT FOR EUTHANASIA

Date:
Owner's name and address:.
Description of the dog: Breed:., Sex:.................
Age:., Colour:.
Identification mark, if any:.
Name:
I, the undersigned, do hereby declare that the above animal under description
belongs to me and I as a Owner or my agent (named:.)
hereby give Doctor:his agent, representatives full
and complete authority to sacrifice the mentioned dog in whatever manner the said
Doctor:.shall deem fit; and I do hereby and by these
presents forever release the said doctor his agent, representatives from any and all
liabilities for so destroying the said animal.
I do also certify that the said animal has not bitten any person or animal during the
last fifteen (15) days, and to the best of my knowledge has not been exposed to rabies.

Full Signature:.
Address:..

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