Pet License Form

2. Owner's First Name*

3. Owner's Last Name*

5. Street Address*

6. Mailing Address*

8. Name of Pet*

9. Breed Of Dog*

11. Pet Description (Colour, etc)*

13. Sex Of Pet*
    -- Select One --MaleFemale

    Please select the sex of your pet

14. Proof of Spay or Neuter Enclosed?

    Only required if first time registering for a license in Bighorn

    1. Yes
    2. No
    3. No - Renewal MD Already Has Form
15. Pet License Pricing*

    1. Non Spayed or Neutered Dog $100.00
    2. Spayed or Neutered Dog $20.00
    3. Vicious Dog $300.00

    Please select the one that applies. Must provide proof of spay or neuter certificate.

17. Birthdate Of Pet*
    Birthdate Of Pet

19. * The above information can be used to reunite pets and owners, so if your dog has registered tattoos or a microchip, this information should also be provided.

21. Tags/Tattoo’s or Microchip information:

22. Payment Method*
    -- Select One --Cheque (Mail or In-person with copy of pet license)E-Transfer (sent to finance@mdbighorn.ca)Credit Card (Phone 403-673-3611)

    Please select the payment Method from Dropdown box E-Transfer - password must be sent in separate email. If submitting cheque please print form and mail or bring in to office with payment.

24. How & Where to send your form

    Drop off, Mail, Fax or Email completed form, appropriate fee and other additional information to: M.D. of Bighorn Box 310, #2 Heart Mountain Drive Exshaw, AB T0L 2C0 Fax: (403) 673-3895 Email: finance@mdbighorn.ca

    Drop off, Mail, Fax or Email completed form, appropriate fee and other additional information to: M.D. of Bighorn Box 310, #2 Heart Mountain Drive Exshaw, AB T0L 2C0 Fax: (403) 673-3895 Email: finance@mdbighorn.ca

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25. Print Only

* indicates a required field