Survival Kit - Service Dog Survival Information

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Name of owner:

Phone:

Address:

City: State: Zip:

Dog’s Name: Age: Male ____ Female ____

Breed: Color:

Approx. Weight:

Any markings on dog:

Tattoo#:

Microchip/Avid Chip #:

FOOD:

type/Brand of dog food:

Amount of food given per day:

Dog’s medications (if any):

GUIDE DOG SCHOOL INFORMATION

Name:

Address:

City/State/Zip:

Phone:

Name of Dogs veterinary clinic:

Address:

City: State: Zip:

Phone:

EMERGENCY CONTACTS

1. Name:

Address:

City: State: Zip:

Phone: Relationship:

2. Name:

Address:

City: State: Zip:

Phone: Relationship:

ANY ADDITIONAL INSTRUCTIONS

Notes:

Include a recent photo of your dog and yourself for easy identification if you become separated.

Store all paperwork in a water tight plastic bag and/or water tight plastic container.