Euthanasia Authorization Form

Download printable Euthanasia Authorization Form here.

 

Equine Information

BEHS-Name:

Description of condition/injury/illness that led to decision to euthanize:

 

Foster Information

Name:

Phone Number:

Address:

City, State, Zip:

Foster Home Comments:

 

 

 

Veterinarian Information

Name:

Phone Number:

Address:

City, State, Zip:

Veterinarian Comments:

 

 

 

Date euthanasia performed: _________________________________________

Location: ________________________________________________________

 

Signatures

I, the undersigned officer or director of Bluebonnet Equine Humane Society, authorized the euthanasia of the horse based on the above comments from the veterinarian and/or foster home on this date.

 

Name:

Title:

 

____________________________
Officer/Director Signature

 

__________
Date