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2. Please complete the online form below to submit your dog license application
4. Contact Information
6. First Name*
7. Last Name*
9. Address1*
11. City*
12. State*
13. Zip*
15. Home Phone Number*
16. Cell Phone Number
18. Email Address*
20. Name of Dog*
21. Gender*
    -- Select One --MaleFemale
22. Spay/Neuter*
    -- Select One --YesNo
24. Description of dog*
26. Age*
27. Breed*
28. Color*
30. Please upload proof of current rabies vaccination*
32. PLEASE HELP CONTROL THE PET POPULATION, HAVE YOUR PET SPAYED OR NUETERED.
    ALL ANIMALS IN THE CITY OF BELOIT MUST BE ON A LEASH, CHAIN OR RETAINED BY A SECURED ENCLOSURE AT ALL TIMES. ANIMALS RUNNING LOOSE OR CAUSING A DISTURBANCE WITHIN THE CITY LIMITS MAY BE IMPOUNDED. DOG LICENSE APPLICATION ARE LIFETIME REGISTRATION FOR EACH REGISTERED DOG. THE OWNER IS RESPONSIBLE FOR PROVIDING THE CITY WITH CURRENT RABIES IMMUNIZATION AS LONG AS THE DOG REMAINS AND IS KEPT WITHIN THE CITY.
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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

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