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Please provide us a way to contact victim or person filling
out form we need additional information!!!
Personal contact information will
Date of Attack:
Country not Listed:
Age when bitten:
It may also be entered into
our online database (no personal contact info).
Many places have a disclosure at the bottom that allows them
to use the information you provided as they want.
We discourage survivors from agreeing to this.
Make sure you know exactly how your attack information is
being used, by who, when, and for what reason.
VERY IMPORTANT!!! There are Land Sharks who's bite can be
worse than the original shark bite.