4. Owner's First Name*
5. Owner's Last Name*
7. Email or Phone*
9. Street Address*
10. Mailing Address*
12. Name of Pet*
13. Breed Of Pet*
15. Pet Description (Colour, etc)*
17. Sex Of Pet*
    -- Select One --MaleFemale

    Please select the sex of your pet
18. 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
19. Proof of Neutered or Spayed Dog
    Please provide proof of your dog being neutered or spayed. If you haven't already done so.
20. Pet License Pricing*

    1. Non Spayed or Neutered Dog $75.00
    2. Spayed or Neutered Dog $30.00
    3. Vicious Dog $300.00
    4. RePlacement Tag $10.00

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

22. Tattoo’s or Microchip information:
23. Photo
    Upload a photo of your dog here.
25. * The above information can be used to reunite dogs and owners, so if your dog has registered tattoos or a microchip, this information should also be provided.
27. Payment Method*
    -- Select One --Credit Card (OptionPay Portal)Cheque (Mail or In Office with Last Name)Cash or Debit In Office

    Please select the payment method from the dropdown box. Credit Card payments are through the OptionPay portal. If submitting cheque by mail please identify dog owner(s) name on cheque stub. Credit card payments will direct you right to options pay website, you will pay the amount you highlighted on this form. 

29. How & Where to send your form
    This form is submitted to the MD via email. If you would like to make payment via cheque, ensure Pet Owner name is included and then mail or drop off appropriate fee to: M.D. of Bighorn Box 310, #2 Heart Mountain Drive Exshaw, AB T0L 2C0 Fax: (403) 673-3895 Email: finance@mdbighorn.ca
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field