Test Dog Form – Boone County Conservation District

Owner Information

Owner Last Name*

Owner First Name*

Owner Middle Name*

Address*

Street Address City State ZIP Code

Are you a Boone County Resident?*

Yes
No

Phone*

Email*

Enter Email Confirm Email

How did you hear about us?

Emergency Contact

Name*

First Last

Relationship*

Phone*

FULL SEASON TAG (January – December):
$35 ($45 non-resident): $15 additional dog

HALF SEASON TAG (July – December):
$20 ($25 non-resident); $10 additional dog

ONE-DAY POOCH PASS:
$3 for one dog, $1 for each additional dog

Dog(s)

Dog #1

Name*

Breed*

Age*

Sex*

Male
Female

Spayed/Neutered?*

Yes
No

Current Rabies Tag #*

County*

Add another Dog?*

Yes
No

Dog #2

Name*

Breed*

Age*

Sex*

Male
Female

Spayed/Neutered?*

Yes
No

Current Rabies Tag #*

County*

Add a third dog?

Yes
No

Dog #3

Name*

Breed*

Age*

Sex*

Male
Female

Spayed/Neutered?*

Yes
No

Current Rabies Tag #*

County*

Tag Type*

Full Season (Jan-Dec)
Half Season (July - Dec)
One Day Pooch Pass

Date the Pooch Pass Will Be Used*

License Fees

Price: $0.00

Would you like your tag(s) mailed? There's a $1.50 charge to cover postage. If you answer no to this question, you'll need to pick up your tag(s) at the office.

Yes
No

Postage Fee

Price: $1.50

Credit Card Processing Fee

Price: $0.00

Total

$0.00

By typing my name and date below, I signify that I have read and agree to the WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK here

My Signature*

Today's Date*

Hammertime Dog Permit

Owner Information

Emergency Contact

Dog(s)

Dog #1

Dog #2

Dog #3

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