In Case Of An Accident/emergency Form
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(Place this page in your automobile, RV, or whatever vehicle you may be driving or on your person when you are traveling with your dogs.)
In the event that I am incapacitated and unable to make my wishes known regarding my dog(s), please
honor the following requests:
The welfare of my dog(s) is my primary consideration.
Contact as soon as possible: ______________________________________________
Day Telephone Number: _____________________________________________
Night Telephone Number: _____________________________________________
Cell Telephone Number: ______________________________________________
If they cannot be reached,
Please Contact: __________________________________________________________
Day Telephone Number:
____________________________________________
Night Telephone Number: _____________________________________________
Cell Telephone Number: ______________________________________________
All expenses for the dog(s) will be guaranteed by these contact people.
If my dog(s) is not injured, they are to be cared for by the nearest reputable boarding kennel, and be kept in the
best possible manner until arrangements can be made to get them home.
If my dog(s) is injured, they are to be cared for by the nearest reputable veterinarian. I prefer that my veterinarian
be contacted regarding decisions on my dog(s) care and treatment. They have all of my dog(s) medical records
available.
Contact my veterinarian: _____________________________________________________
Day Telephone Number: ________________________________________________
Night Telephone Number: _______________________________________________
Emergency Telephone Number: __________________________________________
If my dog(s) is injured beyond all hope of recovery, my dog(s) is to be humanely euthanized. Photographs and
descriptions of my dog(s) are attached, as are their health and vaccination records. For identification purposes,
my dogs are either tattooed on their ________________ with a tattoo number or are micro-chipped and can be
identified by a reputable veterinarian.
I want to emphasize that the welfare of my dog(s) is my primary consideration.
Signature: _________________________________________________________________
Date: _____________________________________________________________________
Name: ____________________________________________________________________
Address: __________________________________________________________________
City: _________________________________State: _____________ Zip: _______________
Day Telephone Number: ______________________________________________________
Work Telephone Number: _____________________________________________________
Spouse/Significant Other: _____________________________________________________
Parents: ___________________________________________________________________
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