Dog Registration Submission Dog Registration Form Type:* NEW (Form must be completed entirely) RENEWAL (If renewal, complete owner name, pet name and any info that has changed only) Owner Name:* First Last Phone*Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Email* Owner Name (2) (if more than one owner): First Last PhoneAddress Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Email Dog's Name* Dog's Gender* Male Female Dog's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Breed* Colors* Special Markings Size:* Small Medium Large Microchip Implant?* Yes No If Yes, Microchip Number* Tatooed?* Yes No If Yes, Tattoo Number & Location* Dog Dangerous to People?* Yes No Dog Dangerous to Other Animals?* Yes No Dog Spayed or Neutered?* Yes No Total Fee to be PaidLicense Fee is $25.00 for 3 years. If a dog is spayed or neutered, fee shall be reduced by $10.00. If dog has a microchip and number, fee shall be reduced by $5.00. Consent* I agree to the privacy policy stated below.The City of Corner Brook uses this web form to collect your information in order to better administer programs and services that citizens use and rely on. The City of Corner Brook committed to protecting the privacy of individuals who chose to utilize these services. This information is collected in compliance with the Access to Information and Protection of Privacy Act, 2015 (ATIPPA, 2015) and will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose unless you expressly consent otherwise. This information is not disclosed to other public bodies or individuals except as authorized by ATIPPA, 2015.
