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.

Name

Address

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