ANIMAL USE CONSENT FORM – Instructions for Use
The Animal Use Consent Form Template is designed for use by Principal Investigators of research projects that will
involve privately-owned animals.
The projects may range from procedures as simple as observing an animal’s gait for lameness to surgical procedures.
All research projects conducted at Charles Sturt University which involve animals, which are privately owned, must
have the consent of the animal’s owner that their animal can be used as part of the project. A Consent Form template
has been designed which researchers can download, tailor for use in their particular project and save to be printed
and given to animals’ owners to sign.
Some information in the Consent Form is mandatory; some information is able either to be tailored so that the
information is relevant to the project, or be removed, amended or added for relevance.
Information that is mandatory, but will require details specific to the project is enclosed in the < > symbols.
Information which may be removed if irrelevant to your project is enclosed in the # # symbols.
Please ensure that your Consent Form is included with the Animal Research application when submitting the
application to the Animal Care and Ethics Committee.
CONSENT FORM
I, the undersigned, acknowledge that I am the owner or caretaker of
(*Dog / cat / Horse / Foal etc. name) …………………………………………….., a (age or date foaled) ………..
(sex) …………………………………. (breed) ……………………….. who is (entire / desexed).
I acknowledge my willingness to enter <species name> in the research study entitled “<Name of Research Project>”
at <venue where research work is to be conducted>.
I understand that the intention of the study is:

<enter details of the aims of the research project>.
#I understand that the study may require that the <species name> may be sedated, but that this is anticipated to be
safe for the <species name>.#
I also understand that if <enter any details about additional procedures that may be necessary during the course of
the research project> the veterinarian / <Principal Investigator> will discuss this with me first as <this procedure is
performed with the <species name> under general anaesthesia / other conditions>.
I recognise that the benefits anticipated from my participation in this study include:
 <benefit 1>
 <benefit 2>
 <benefit 3>
#I understand that my financial obligations during participation in this study are limited to those which would normally
be incurred by the diagnosis and treatment of my animal for this condition.#
#I understand that I will incur no financial costs as a result of my participation in this study.#
#I understand that my animal’s participation in this study will remain confidential but that I will be informed of any
significant findings of <nature of procedures> performed on my <species name>.#
I consent to research data resulting from my <species name>’s involvement in this project being published, with all
information identifying my individual animal being firstly removed.
I am aware that this research has been reviewed and approved by the Animal Care and Ethics Committee of Charles
Sturt University.
I am aware that the Principal Investigator of this study is <Name of Principal Investigator> <qualifications>, who may
be contacted by me if questions arise regarding this study on telephone <telephone number>.
Name of Owner
..............................................................................................................................
Signature of Owner
...............................................................
Date
......................................
Attending Veterinarian
...............................................................
Date
......................................