Pot-bellied Pig License Application
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Pet Owner Information
Required
Owner/custodian:
Required
One owner name only please
Required
Address:
Required
City
*
Required
State
*
Enter a Valid US State
Required
Zip
*
Minimum 5 characters required.
Required
Mailing and physical addresses are the same
Mailing Address
*
Required
Mailing City
*
Required
Mailing State
*
Minimum 2 characters required.
Required
Mailing Zip
*
Minimum 5 characters required.
Required
E-Mail Address
*
Please, enter valid e-mail address.
Required
Primary Phone
*
Minimum 10 digit phone required.
Required
Secondary Phone
Minimum 10 digit phone required.
Required
Vet Name
Required
Vet Phone
Minimum 10 digit phone required.
Required
Address
*
Required
City
*
Required
State
*
Enter a Valid US State
Required
Zip
*
Minimum 5 characters required.
Required
Animal Information
Species
*
select
Cat
Dog
Pig
Pig
Required
Pet Name
*
Required
Sex
*
select
Female
Male
Required
Height
*
Required
Weight
*
Required
Month Born:
*
select
Unknown
January
February
March
April
May
June
July
August
September
October
November
December
Required
Year Born:
*
select
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Required
Required
I certify that this animal has been surgically altered by a licensed veterinarian.
Please upload proof of Vaccination
Required
Please upload proof of Neutered/Spayed
Required