Canine EmergencyInformation

For Animals in My Care

Name

Address

City,State, Zip

HomePhone

WorkPhone

CellPhone

RegistrationInformation for Canine

Nameof Dog

RegistrationNumber

Breed

Sex

ColorDescription

Dateof Birth

Owner(s)on Registration Papers

Incase of an emergency, please provide all medical care necessary to properlycare for any animal(s) being transported in this vehicle. Their care and safetyare of utmost importance. All costs including vet care, boarding or any otheritems needed for their immediate care and safe return will be covered by myselfor my family if I am not able to do so.

Signature

PrintLegal Name

Thefollowing people AGREE and KNOW how to take care of my animals.

#1 Name          Relationship

Address

City,State, Zip

HomePhone

WorkPhone

CellPhone

#2 Name          Relationship

Address

City,State, Zip

HomePhone

WorkPhone

CellPhone

#3 Name          Relationship

Address

City,State, Zip

HomePhone

WorkPhone

CellPhone

#4 Name          Relationship

Address

City,State, Zip

HomePhone

WorkPhone

CellPhone

Veterinarywhere my animal’s records are:

Name

Address

City,State Zip

PhoneNumber

Afterhours policys:

AnimalsGenerally in My Care

Animal # 1       Animal # 2

CallName          CallName

Sex          Sex

ColorDescription          ColorDescription

PermanentID          PermanentID

HealthIssues          HealthIssues

Medications          Medications

Food          Food

Behaviors          Behaviors

Animal # 3       Animal # 4

CallName          CallName

Sex          Sex

ColorDescription          ColorDescription

PermanentID          PermanentID

HealthIssues          HealthIssues

Medications          Medications

Food          Food

Behaviors          Behaviors

(Developed and Providedby Sharon Wilson)