Local Government Insurance Trust
Police K9 Application

Member	

Contact	

Phone		

How often medical 
checkups and vaccinations?	___________________________________________

Overnight stay 
(kennel, home, etc)?	_________________________________________________

Did K9 receive a warrant of 
perfect health and fitness to perform its duties?	_________________________

Police K9 Schedule
K9 Type,
ID#, Name	K9 Cost
before
Training	K9 Cost
after
Training	Types of 
Training	Age	Any Pre-existing Conditions	Health
Status	

							

							

Loss Schedule
Date of Loss	Loss Description	Amount	Open or Closed	

				

Signature	________________________________	Date__________________

c\scott\property\K9\app