This questionnaire’s sole purpose is to gather information on any and all airline incidents involving pets even if the incident was not formally reported, i.e.; delays, check-in, receiving, loss of pet (even if later found), pet injuries, death of pet, etc. Please complete the questions below as detailed as possible and return the completed form either by email to Pawsativebf@aol.com, fax 516-379-0975, or by mail to Vivi Crusade, 3392 Bay Front Place, Baldwin, NY 11510. Your responses will be kept confidential unless you agree to disclosure. Thank you in advance for your participation.

Owners name ________________________________________

Owners address ________________________________________
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Email address ________________________________________

Phone (optional) ________________________________________

Type of pet ________________________________________

Breed of pet ________________________________________

Age of pet at time of incident ___________

Overall health of pet at time of incident _____________________________________
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Date of Incident____________________________ Flight #_______________________

Airline/Airlines ______________________________________________________

Airport/s & City/ies ______________________________________________________

Weather conditions ______________________________________________________

Reason for travel- Examples: sale, breeding, move, vacation, dog show, etc.
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Was your pet traveling with you? ______ If not, who was pet traveling with?
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Did you supply your own crate or did you purchase it from the airline?
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What brand was the crate, if you recall? ____________________________________
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Was the flight non-stop _____ or how many stops _______

In the event your pet was injured, lost (even for a brief period of time),
or if your pet died, how did the airline personnel notify you?
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Did you/they fill out a report? ______ Do you have a copy? _______

Did they offer any compensation? __________________________________________

Was there any subsequent follow-up on yours or the airlines part to the incident?
If so, please describe _____________________________________________________
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Please feel free to add any comments regarding your experience that may not have
been covered by the above questions. Use as much space as needed.
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Yes______I agree to disclosure No_____I wish to remain anonymous

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Signature Date

Thank you for taking the time to fill out the Vivi Crusade Questionnaire. It is with your help that we will make a difference, in the future, for our pets to be safely transported via the airlines.
www.vivicrusade.org