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Dog Licence Application Form
City of Maple Ridge Updated Feb 2017
11995 Haney Place, Maple Ridge, BC V2X 6A9 Tel: 604-467-7384 Fax: 604-467-7445
Email inquiries: licencesandbylaws@mapleridge.ca Web Site: www.mapleridge.ca
A dog licence helps you reunite with your dog if they are lost anywhere in the world. Dog licence fees not only support
the return of pets to their owners, they assist in the adoption of homeless pets every year. Fees also pay for educat ion
and enforcement of our Animal Control and Licencing bylaw, as well as the cost for operating the local animal shelter.
FEES ON FOR BEFORE JANUARY 31 : ALTERED $25.00 OR UNALTERED $52.00
SENIORS (65+ ID REQUIRED) $12.50 (ALTERED) OR $26.00 (UNALTERED)
FEES ON OR AFTER FEBRUARY 1: ALTERED $41.00 OR UNALTERED $68.00
SENIORS (65+ ID REQUIRED) $20.50 (ALTERED) OR $34.00 (UNALTERED)
DOG OWNERS NAME:
ADDRESS AND POSTAL CODE:
TELEPHONE AND CONTACT
INFORMATION:
HOME: WORK:
MOBILE:
EMAIL ADDRESS:
DOG(S) INFORMATION: SPAY/NEUTER CERTIFICATES ARE REQUIRED AT THE TIME OF APPLICATION. 3 DOGS ALLOWED PER PROPERTY, UNLESS YOU
QUALIFY FOR A HOBBY KENNEL LICENCE.
DOG #1
NAME:
BREED:
COLOUR:
SEX: (CIRCLE) MALE OR FEMALE
FIXED: (CIRCLE) SPAYED OR NEUTERED
MICROCHIP/TATTOO #:
DOG #2
NAME:
BREED:
COLOUR:
SEX: (CIRCLE) MALE OR FEMALE
FIXED: (CIRCLE) SPAYED OR NEUTERED
MICROCHIP/TATTOO #:
DOG #3
NAME:
BREED:
COLOUR:
SEX: (CIRCLE) MALE OR FEMALE
FIXED: (CIRCLE) SPAYED OR NEUTERED
MICROCHIP/TATTOO #:
PRIVACY: INFORMATION COLLECTED ON A DOG LICENCE APPLICATION IS COLLECTED UNDER THE AUTHORITY OF SECTION 47 OF THE COMMUNITY CHARTER.
PERSONAL INFORMATION COLLECTED IS PROTECTED PURSUANT TO THE FREEDOM OF INFORMATION AND PROTECTION ACT.
FORM COMPLETED BY:_______________________________________ SIGNATURE:_____________________________________
DATE:_________________________
OFFICE USE ONLY
DOG TAG NUMBER(S): ACCOUNT NUMBER:
PAYMENT RECEIVED: □ YES □ NO
□VISA □MASTERCARD □AMEX □DEBIT □CHEQUE □CASH AMOUNT : $______________