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Wild Animal License

Application Type

New Application Renew License

Pet Owner Information

Owner/custodian of animals: One owner name only please

Home Address:
City* State* Zip*

Mailing and physical addresses are the same

Mailing Address*
Mailing City* Mailing State* Mailing Zip*

Business Name
Address
City State Zip
Primary Phone Secondary Phone

E-Mail Address*
Primary Phone* Secondary Phone

Vet Name Vet Phone

Address*
City* State* Zip*

Emergency Contact*
Address*
City* State* Zip*
PrimaryPhone* Secondary Phone

Alternate Caretakers

Alternate Caretaker
Address
City State Zip
Primary Phone* Secondary Phone
Alternate Caretaker
Address
City State Zip
Primary Phone Secondary Phone

Pet Information

Species of animal(s)*

Number of animals:*

Gender*

select

Year Born*

select

Weight*

Please upload proof of all vaccinations

Description of animal(s):*

Address where animal(s) will be located*
City* State* Zip*

Detailed description of enclosure animal(s) will be kept in:*

The purpose of maintaining this animal(s):*

Is the property that said animal(s) is located on, owned or rented by the animal owner/custodian? Owned Rented Do you have liability insurance, or a surety bond, to insure you for any personal injuries inflicted by the animal(s) Yes No

Emergency procedure - please describe available resources, plans, equipment or techniques for the capture or control of the said animal(s) if escape occurs.*

Is said animal(s) licensed by any other agency? Yes No
Is said animal(s) of the venomous species? Yes No

A wild animal license fee is $100.00 annually and is valid 12 months from date of issuance.

By applying for this license, I agree to comply with Clark County and/or city of Vancouver ordinances and regulations as they relate to the care and/or safety of the animals

I certify that the facts and information in this application and in any attachements or supporting docuents are true and complete to the best of my knowledge.