Type Full Name :
Sign With Hand
Last Name
City
Middle Initial
Size
Owner Information
Sex
Phone #
Color
{[PNAME]}
Address
Species
Applicant Signature
Important Notice
First Name
ZIP
First Name
If applicable, provide details of another owner for this pet that resides at the same address.
Last Name
Pet Name
By submitting this form, I am confirming that all of the information I have entered is accurate, according to the best of my knowledge. I understand that failure to provide correct information will result in revocation of my pet’s license.
Phone #
Spayed/Neutered?
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
https://www.ourclark.com/
The Health Department is hosting a free rabies vaccination clinic open to the public, working hours are 6:00 PM - 7:00 PM. This clinic is not restricted to Clark residents — all are welcome.

To reduce wait times and streamline clinic operations, please pre-register your pet(s) using this form. A separate form is required for each animal.

Upon submission, your registration will be securely sent to the Health Department. Vaccination certificates will be issued at the event.
State
Email
Pet Information
Certification
Predominant Breed
Age
Address 2
Email