2. 

3. Animal Registration Form

5. Please fill out the following form for up to three household animal registrations. If more animals are required to be registered, submit another registration form after the initial three (3) are registered. Please retain for your records.

7. Animal 1 Type

   1. Dog
   2. Cat
8. Animal 1 Gender

   1. Male
   2. Female
9. Animal 1 Breed
10. Color
12. Animal 1 Rabies No.
13. Animal 1 Rabies Expiration Date
14. Spayed/Neutered

    1. Yes
    2. No
15. Microchip ID No.
17. Animal 1 Markings

    Please describe any animal markings.

19. Animal 1: Prior Animal Ownership*

    1. Yes
    2. No

    Please indicate if the owner has previously owned an animal within the last ten (10) years that was determined to be a dangerous or vicious animal in any jurisdiction. Such disclosures shall identify the jurisdiction making such determination and the date or dates of all determinations. 

    If Yes, please answer the questions below:

20. Animal 1: Dangerous or Vicious Determination*

    1. Yes
    2. No

    Please indicate whether the dog or cat for which a registration has been made has previously been determined to be a dangerous dog or a vicious animal in any jurisdiction.

22. If Yes, Jurisdiction:
24. If Yes, Dates:
28. Animal 2 Type

    1. Dog
    2. Cat
29. Animal 2 Gender

    1. Male
    2. Female
30. Animal 2 Breed
31. Color
33. Animal 2 Rabies No.
34. Animal 2 Rabies Expiration Date
35. Spayed/Neutered

    1. Yes
    2. No
37. Microchip ID No.
39. Animal 2 Markings

    Please describe any animal markings.

41. Animal 2: Prior Animal Ownership*

    1. Yes
    2. No

    Please indicate if the owner has previously owned an animal within the last ten (10) years that was determined to be a dangerous or vicious animal in any jurisdiction. Such disclosures shall identify the jurisdiction making such determination and the date or dates of all determinations.

    If Yes, please answer the questions below:

42. Animal 2: Dangerous or Vicious Determination*

    1. Yes
    2. No

    Please indicate whether the dog or cat for which a registration has been made has previously been determined to be a dangerous dog or a vicious animal in any jurisdiction.

44. If Yes, Jurisdiction:
46. If Yes, Dates:
50. Animal 3 Type

    1. Dog
    2. Cat
51. Animal 3 Gender

    1. Male
    2. Female
52. Animal 3 Breed
53. Color
55. Animal 3 Rabies No.
56. Animal 3 Rabies Expiration Date
57. Spayed/Neutered

    1. Yes
    2. No
58. Microchip ID No.
60. Animal 3 Markings

    Please describe any animal markings.

62. Animal 3: Prior Animal Ownership*

    1. Yes
    2. No

    Please indicate if the owner has previously owned an animal within the last ten (10) years that was determined to be a dangerous or vicious animal in any jurisdiction. Such disclosures shall identify the jurisdiction making such determination and the date or dates of all determinations.

    If Yes, please answer the questions below:

63. Animal 3: Dangerous or Vicious Determination*

    1. Yes
    2. No

    Please indicate whether the dog or cat for which a registration has been made has previously been determined to be a dangerous dog or a vicious animal in any jurisdiction.

65. If Yes, Jurisdiction
67. If Yes, Dates:
71. Name
72. Email Address
74. Address
76. City
77. State
78. Zip Code
80. Phone Number
81. Fax Number
Leave This Blank:


83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field