Canine Emergency Information

For Animals in My Care

Name

Address

City, State, Zip

Home Phone

Work Phone

Cell Phone

Registration Information for Canine

Name of Dog

Registration Number

Breed

Sex

Color Description

Date of Birth

Owner(s) on Registration Papers

In case of an emergency, please provide all medical care necessary to properly care for any animal(s) being transported in this vehicle. Their care and safety are of utmost importance. All costs including vet care, boarding or any other items needed for their immediate care and safe return will be covered by myself or my family if I am not able to do so.

Signature

Print Legal Name

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

# 1 Name Relationship

Address

City, State, Zip

Home Phone

Work Phone

Cell Phone

# 2 Name Relationship

Address

City, State, Zip

Home Phone

Work Phone

Cell Phone

# 3 Name Relationship

Address

City, State, Zip

Home Phone

Work Phone

Cell Phone

# 4 Name Relationship

Address

City, State, Zip

Home Phone

Work Phone

Cell Phone

Veterinary where my animal’s records are:

Name

Address

City, State Zip

Phone Number

After hours policys:

Animals Generally in My Care

Animal # 1 Animal # 2

Call Name Call Name

Sex Sex

Color Description Color Description

Permanent ID Permanent ID

Health Issues Health Issues

Medications Medications

Food Food

Behaviors Behaviors

Animal # 3 Animal # 4

Call Name Call Name

Sex Sex

Color Description Color Description

Permanent ID Permanent ID

Health Issues Health Issues

Medications Medications

Food Food

Behaviors Behaviors

(Developed and Provided by Sharon Wilson)