Type Full Name :

Sign With Hand

Last Name

License Duration Requested?

If "Other", specify

Required Documents

How do you intend to make payment for this application *

Owner Information

Sex *

Age *

Phone # *

Is Rabies Vaccination Exempt? *

Color *

{[PNAME]}

Phone # *

1.  New Registrations
     All new applicants must include a valid Rabies Certificate and Spayed/Neutered Certificate before a license can be issued.
     The Rabies Certificate must be valid for at least ten months of the licensing year.
     
2.  Renewals
     Renewals must include a valid Rabies Certificate.
     The Rabies Certificate must be valid for at least ten months of the licensing year.

3.  Service Dogs
     All applications for Service Dogs must include a valid Service Dog Registration Certificate.

Address *

{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}

Hair Length *

Applicant Signature *

First Name *

Expiration Date *

Amount Due

First Name

Is Valid?

If applicable, provide details of another owner for this dog that resides at the same address.

Veterinarian Information

Last Name *

Dog's Name *

Is this Application for a New Dog or Renewal?

I acknowledge that all statements made herein are accurate and that this application will not be accepted as submitted until all required documents are remitted, and all applicable fees are paid. I acknowledge that if no payment is made within 72 hours of this application, it will be deemed null and void, and I will be required to make a new application.

Phone #

Is Spayed/Neutered? *

Based on the selection above, additional instructions will be emailed upon submission.

Checks can be mailed with a self addressed stamped envelope to:

Borough of Atlantic Highlands
100 First Avenue
Atlantic Highlands, NJ 07716

The reference number must be stated on all checks. The reference number will be displayed upon submission and can be found in the email sent upon submission.

Note that payment must be received in full before a Dog License and Registration Tags can be issued.

A renewal license must be paid for prior to March 1st, after that a $5.00 late fee will be charged.

License Fee

Vaccination Date *

Email *

Address *

Dog Information

Name *

Certification

Documents

Breed *

Address 2

{[CNAME]}

Is this a Service Dog? *

Vaccination Information

Previous License # (if known)

Specify Address where BOTH Dog and Owner reside *