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Trapping Incident Report Form

We know that it may be difficult for you, but if you are able to take photos of the incident and/or of the victim after treatment if applicable, that will help provide "proof" for media, legislators, prosecutors, etc. You'll find an address to send photos and newspaper articles at the bottom of this form.

Or you may download a form you can print, fill out, and send to us.

Fields marked with an asterisk are required.

Information About You:

* First name
* Last name
* Address 1
Address 2
* City
* State or Province	Choose Your State or Province Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Federated States of Micronesia Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavat Ontario Prince Edward Island Quebec Saskatchewan Yukon
* Zip Code/Postal Code
* Email Address
Phone (with Area Code)

Information About the Incident:

Date of Incident	MM/DD/YY
Species of Trap Victim
Name of Trap Victim (if known)
Type of Extent of Injury (check all that apply)	swelling cut death		bruising broken bones other
If Other, please describe
If Amputation name appendage
Estimated Time in Trap
Type of Trap	steel-jaw leghold conibear other		snare unknown
If Unknown or Other please describe

Location of Incident

City
State/Province	Choose Your State or Province Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Federated States of Micronesia Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Zip Code or Postal Code
Describe Area (near homes? on trail? near campground? etc.)
Name of Attending Veterinarian or Doctor
Treatment Description
Treatment Cost
Additional Notes about Incident
To What Agency Was This Incident Reported (if any)
Was Trap Owner Found	Yes No
Was Owner Charged with Violation

Are You Willing to Help Us?

Would you or anyone associated with this incident be willing to testify on the behalf of, or in cooperation with, Born Free USA united with API to end the cruelty of trapping? Yes No
If Yes, please list names and contact information
List any additional details you feel would be helpful

Please send copies of any newspaper articles and photos of this incident to:

Trapping Incident
c/o Born Free USA united with API
P.O. Box 22505
Sacramento, CA 95822
info@bornfreeusa.org