Owner’s Authorization To Treat A Sick or Injured Animal During A Disaster


I, ­­­­­­­­­­­­­­­­­­­­­­­­­­­____________________________________________, give the following individual(s) permission to get treatment for my animals, if my animals were to be injured during a disaster and I was unable to do so.




Phone Number(s)

Driver’s License #

















This permission would apply for the following animals:


 Animal’s Name

Type of Animal

Brief Description














The veterinarian I would prefer my animals be taken to is:  (another veterinarian may be used if this veterinarian is not available)



_________________________________           ______________________________________    _______________________________

                  Veterinarian’s Name                                                      Address                                                         Telephone Number


I accept full financial responsibility for any medical treatment necessary to relieve the suffering of the animals listed above.


_________________________________           ______________________________________    _______________________________

Owner’s Name                                                         Address                                                         Telephone Number