Edit Existing?
Canine Counts.
Location of DOG to be REGISTERED
*
Ward Number
MotoPaws Collar Code
Name
Ownership Status
*
Owned
Free Roaming
Color
*
describe in detail
Age
*
Puppy 0 - 8 months
Adolescent 8 months - 3 years
Adult 3 - 8 years
Senior 8+ years
Sex
*
Male
Female
Lactating Female
Pregnant Female
Recognizable Feature
optional
Sterilized?
*
Yes
No (entire)
not sure
Vaccinated?
*
No
DHPPi/ DHPPiL
Rabies
not sure
Date of DHPPiL Vaccine
*
Date of Rabies Vaccine
*
Rabies Batch Number
*
ARV Validity
*
1 year
3 years
Marking Method
*
Unmarked
With Paint
With Collar
Any Injury/ Illness?
*
None
Malnourishment
Mange
Distemper
Parvovirus
Rabies
Cancer
Maggot Wound
Open Wound
Flea/Tick Illness
HeartWorm Disease
Limb Disfigurement
Eye Problem
Other - Please Specify
Please Describe Illness as You see it
Medical Notes
Is there a Responsible Local carer?
*
Yes
No
Carer Name
First Name
Last Name
Carer Phone Number
Dog Temperament
*
FRIENDLY /PETTING
SCARED BUT APPROACHABLE
INDIFFERENT
SNAPPY /GROWLING/AGGRESSIVE
UNAPPROACHABLE
ATTACKING/BITING
No. of Rabies Cases in area in past 1 year?
*
No. of RoadKills in the area in last year?
*
Your Name
*
First Name
Last Name
Your Phone Number
Your Email
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