Registration Date: Owner's Information: Last Name: First Name: Address: Apt/Suite: City: State: Florida Zip Code: Home Phone: Cell Phone: E-Mail: Use internet-style format (e.g. abc@abc.com) Date of Birth: Driver's License Number: Total number of people in your group: (maximum of 2 people; additional family members will need to stay at the Park Vista High School Shelter): Please enter only numbers Emergency Contact Information: (This should be someone who does not live with you but is authorized to pick up your pet.) Last Name: First Name: Phone: Pet Information for Pet 1: Type of Pet: Dog Cat Other Pet's Name: Gender: Male Female Neutered/Spayed: Yes No Breed: Color: Age: Weight: lbs. Rabies Tag #: Rabies Tag Year: Microchip #: Pet Information for Pet 2: Type of Pet: Dog Cat Other Pet's Name: Gender: Male Female Neutered/Spayed: Yes No Breed: Color: Age: Weight: lbs. Rabies Tag #: Rabies Tag Year: Microchip #: Pet Information for Pet 3: Type of Pet: Dog Cat Other Pet's Name: Gender: Male Female Neutered/Spayed: Yes No Breed: Color: Age: Weight: lbs. Rabies Tag #: Rabies Tag Year: Microchip #: Pet Information for Pet 4: Type of Pet: Dog Cat Other Pet's Name: Gender: Male Female Neutered/Spayed: Yes No Breed: Color: Age: Weight: lbs. Rabies Tag #: Rabies Tag Year: Microchip #: