Animal Licensing

Animal Information

Animal's Name*

Age*

Breed*

Color/Description*

Sex*

Female
Male

Spayed/Neutered*

Yes
No

Microchip Information

Number	Company

If your pet has any emergency medical issues, please describe

Please list any emergency medications used by your pet

Medication	Dosage	Frequency	Reason

Upload Rabies Certificate*

Upload Photo of Pet (Optional)

Do you want to license an additional pet?*

Yes
No

Animal's Name*

Age*

Breed*

Color/Description*

Sex*

Female
Male

Spayed/Neutered*

Yes
No

Microchip Information*

Number	Company

If your pet has any emergency medical issues, please describe

Please list any emergency medications used by your pet

Medication	Dosage	Frequency	Reason

Upload Rabies Certificate*

Upload Photo of Pet (Optional)

Owner Information

Owner Name*

First Last

Additional Owner Name

First Last

Phone number*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Alternate Contact

Name	Phone

Purchase License

Coronado Animal License

One, two, and three year licenses are dependent on the expiration date on your pet's rabies vaccine. E.g. If your rabies vaccine expires in 13 months you may only purchase a one year license

(Additional Pet) Coronado Animal License

Total

$0.00

Agreement

Signature*

By signing above, you are also initialing each of the clauses within the body of the Agreement.

Date

Comments

This field is for validation purposes and should be left unchanged.

Coronado Animal License Application

Animal Information

Owner Information

Purchase License

Agreement