Accident Form

Just copy and paste this form to any Word program, then print it.

Also a good form for Rescue groups who transport pets.

IN CASE OF AN ACCIDENT/EMERGENCY

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 (AVID) 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: ___________________________________________________________________

*You might want to consider having your signature notorized.