TRANSFER AND AUTHORIZATION FOR ANIMAL EUTHANASIA BY SOUTH BEND ANIMAL RESOURCE CENTER

TRANSFER AND AUTHORIZATION FOR ANIMAL EUTHANASIA BY SOUTH BEND ANIMAL RESOURCE CENTER
PLEASE READ CAREFULLY
I, {ownername}, ("Owner"), transfer ownership of the animal described in the attached Animal Information Form (hereafter "Animal") to the South Bend Animal Resource Center ("SBARC") for the purpose of euthanasia. By signing this Authorization for Animal Euthanasia by SBARC ("Agreement"), I hereby acknowledge that by transferring ownership to SBARC that I am duly authorizing SBARC to humanely euthanize the animal. I understand that after the transfer of ownership to SBARC my rights to the animal shall only extend to the remains after the euthanasia is performed.
In consideration for SBARC to accept the transfer for humane euthanasia I, and for my heirs, executors, administrators, successors, and assigns, do hereby expressly state, authorize, and agree to be bound by all the terms and provisions in this Agreement, with my initials next to the statements below indicating that I have read and understand them specifically:

The Animal's remains can be returned to me immediately following humane euthanasia. I understand that should I take the animals' remains back, I will bury the remains no less than six feet underground. I understand that this is a federal and state regulation that must be followed and it is my responsibility to ensure the animal is buried according to state and federal regulations. I understand that if I do not take possession of the remains immediately following humane euthanasia, I forfeit all rights to the full remains of my animal.I release, forever discharge, and hold harmless SBARC, the City of South Bend, as well as any of their employees, instructors, agents, officers, contractors, affiliates, volunteers, successors, assigns and any third-parties facilitating this Agreement, from any and all liability claims, demands, or causes of action of any kind, including but not limited to any bodily or personal injuries, and/or property damage, and any consequences resulting from any incident which may occur in the course of, or as a result of this Agreement, which I have now or in the future for myself or my heirs, executors, administrators, successors and assigns, either in law or equity, that might arise from this Agreement.
I have read the Agreement and did seek or at least had the opportunity to seek legal advice. I understand I have given up substantial rights by signing it and have signed it freely and voluntarily without any duress, inducement, assurance, or guarantee being made to me and intend my signature to be a complete and unconditional release of ALL ownership rights in the Animal.
Owner Name Printed:
Owner Signature:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date signed:

MonthDayYear
Authorization for Animal Euthanasia by SBARC accepted by:
SBARC employee name:
SBARC employee signature:
Date signed:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date and time Animal surrendered to SBARC:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Updated 7.2026
Should be Empty: