Rabies Vaccine & Microchip Event Application

When: April 1st from 4P - 6P (drive thru event) & Where: Brenham Animal Services, 1804 Longwood Drive

You must be a resident of Washington County and submit proof of residency (Driver's License, Utility Bill, Mail, Etc.). This must be done via photo submission below. *
Upload proof of residency photo (Driver's License, Utility Bill, Mail, Etc.) *
I understand that I can only bring up to three (3) pets per household to this event. *
A separate form must be filled out for EACH pet that you are bringing to this event. *
All forms must be filled out completely or the forms will be voided. *
Applicant's First Name *
Applicant's Last Name *
Street Address * Include apartment # if necessary
City *	Brenham Chappell Hill Burton Independence Washington
State *	TX
Zip Code *
Phone Number *
Secondary Phone Number * An emergency contact who can be responsible for your pet if you can't be contacted
Email Address * Please enter correctly as this is how we register the microchip
Confirm email
What services do you need for this pet? * To qualify for a rabies vaccine, your pet must be 12 weeks or older to receive a rabies vaccine. Also, you must agree to have your pet microchipped, or the pet must be previously microchipped. For spay/neuter services, staff will contact you about a separate process.	Rabies Vaccine (>12 wks. old & get microchip) Microchip Spay/Neuter (staff will contact separately)
I agree that Brenham Animal Services can administer a microchip and rabies vaccine to my pet (if not previously performed). *
I agree that Brenham Animal Services is not responsible for negative outcomes, including declining health or death. *
Animal Name *
Species *	Cat Dog
Breed * The answer for cat will be Domestic Short Hair, Domestic Medium Hair, or Domestic Long Hair.	Add Breed Anatolian Shepherd Australian Cattle Dog Australian Shepherd Basset Hound Beagle Bernese Mountain Dog Black Mouth Cur Bobcat Border Collie Boston Terrier Bouvier de Flanders Boxer Brittany Spaniel Bull Terrier Catahoula Leopard Dog Cavalier King Charles Spaniel Chicken Chihuahua Chow Chow Cockatiel Cocker Spaniel Corgi Dachshund Dalmatian Doberman Pinscher Domestic Long Hair Domestic Medium Hair Domestic Short Hair Donkey/Mule Dove Duck English Bulldog English Springer Spaniel Ferret French Bulldog German Shepherd Dog Golden Retriever Great Dane Great Pyrenees Greyhound Guinea Pig Hawk Horse Hound Husky Jack Russell Terrier Labrador Retriever Maltese Mastiff Miniature Pinscher Misc Bird Mixed Breed Owl Pit Bull Terrier Pointer Pomeranian Poodle Pug Rat Terrier Retriever Rhodesian Ridgeback Rottweiler Saint Bernard St. Bernard Schnauzer Setter Shar Pei Sheepadoodle Sheep Dog Shepherd Shih Tzu Skunk Snake Terrier Turkey Vulture/Buzzard Welsh Corgi Yorkshire Terrier Yorkie
Animal Age * Do not type any letters. Age must be formatted as such: 3 years and 4 months old = 3.4
Color *	Black Black and Brown Black and Orange Black and Tan Black and White Blue Brown Brown and Black Brown and White Chocolate Cream Fawn Golden Gray and Black Gray and Tan Grey Grey and White Orange Orange and Black Orange and White Red Tan Tan and Black Tan and Gray Tan and White White White and Black White and Brown White and Grey White and Orange White and Tan Yellow
Approximate Weight * Round up to the nearest number. Do not type any letters. (EX: 44.5 would be 45)
Gender *	Male Female
Spayed/Neutered *	NoYes
Microchipped *	Yes No Unknown
Microchip Number If applicable & known
Type (For Internal Use) *	Non-shelter Animal
Signature *	Clear
Date *

All checkbox agreements above apply individually to each animal registered for this event.