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2. Para completar este formulario en Español, haga clic aquí:
   West Valley City Formulario de Redención
4. We are so happy you have found your pet! Please complete this form to help us get your pet back home as quickly as possible! Once submitted our staff members will contact you by phone or email to schedule an appointment.
6. This form must be filled out by the pet owner. *Must be 18 years of age or older*
8. First Name*
9. Last Name*
11. Physical Address*
12. Apartment #
14. City*
15. State*
16. Zip*
18. Proof of address: Bill or statement with your name and address on it. (No driver's license or ID cards accepted as proof of address)
19. Proof of address*
21. Do you have a separate mailing address?*

    1. Yes
    2. No
22. Mailing Address*
24. Apartment #
25. City*
26. State*
27. Zip Code*
29. Phone Number*
30. Alternate Phone Number
31. Would you like to receive a text notifying you when redemption information has been sent?*

    1. Yes
    2. No
32. Number to Text:*
34. Email- Please check email regularly after form submission.*
35. Please attach a photo of your government-issued photo ID.*
37. What language would you prefer to receive the redemption information in?*

    1. English
    2. Spanish
38. Would you like to give permission for a family member or friend to pick up the pet for you?*

    1. Yes
    2. No
40. Who are you giving permission to pick the pet up for you?*

    Requirements:

    -Must be 18 years of age or older

    -Must have their ID with them at pick up

42. Pet's Name*
43. Animal ID # from Petharbor.com*
45. Species*

    1. Dog

    1. Cat

    1. Other
47. Other (Please Specify)*
49. Gender*

    1. Male

    1. Female
51. Has your pet been spayed/neutered?*

    1. Yes

    1. No

    1. Don't Know
52. If yes, please attach a copy of sterilization certificate or other proof of sterilization.*
56. Breed*
57. Color*
58. Age*
62. Is your pet microchipped?*

    1. Yes
    2. No
63. If yes, please provide microchip number.*
64. Are you interested in receiving a $10 microchip for your pet?*

    1. Yes
    2. No
66. What date did your pet go missing?*
    What date did your pet go missing?
68. How did you lose your pet?*
70. Address your pet is missing from*
72. Is your pet current on its rabies vaccination?*

    1. Yes

    1. No
73. *Please note that a current rabies certificate is required to provide proof. If you do not have a copy of the certificate please call your vet and ask them to fax it to us at 801-965-3974.
75. If yes, please attach your pet's current rabies certificate.*
76. Please attach a picture of your pet to prove ownership.*
78. Signature*
    By signing, I am claiming ownership of the animal listed on this form.
79. Today's Date*
    Today's Date
Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit

* indicates a required field