Advance Directive

Golden Retriever Rescue Alliance

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In the event of my death or incapacitation, I wish for the following plan to be implemented for the care and safety of my pets:

I wish for my Golden Retriever(s) :

Name

________________________________________

________________________________________

________________________________________

________________________________________

to be placed with Golden Retriever Rescue Alliance and request that Golden Retriever Rescue Alliance find new permanent family homes for my Golden Retrievers.

If at the time of my death or incapacitation, Golden Retiever Rescue Alliance is non-existent or otherwise unable to accept my Golden Retrievers, I instruct that my Golden Retrievers be placed with

another no-kill Rescue for adoption by a new family.

Further I wish my other pets to be placed as indicated below:

Name

_________________________________________

_________________________________________

_________________________________________

_________________________________________

The veterinarian listed below has cared for my pets, has a copy of this document and has the medical records of my Pets. I hereby authorize my veterinarian to release the medical record of

my pet to the person designated below:

_____________________________

_____________________________

_____________________________

DVM Phone: _____________________________

Address : _______________________________

I hereby designate to carry out my wishes in regard to the

placement of my pets as indicated above.

Signed ________________________________

Signed Date ____________________________

Witness _______________________________

Witness Date ___________________________

Reprinted by permission of Love a Golden Rescue

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