<form-template> <fields> <field type="header" subtype="h1" label="Pet License Registration" class="header"></field> <field type="text" subtype="text" required="true" label="Owner's Name" placeholder="Owner's Name" class="form-control text-input" name="text-1579713689396" value="Owner's Name"></field> <field type="text" subtype="text" required="true" label="Home Address" placeholder="Home Address" class="form-control text-input" name="text-1579713706646" value="Home Address"></field> <field type="text" subtype="text" required="true" label="Mailing Address" placeholder="Mailing Address" class="form-control text-input" name="text-1579713721858" value="Mailing Address"></field> <field type="text" subtype="text" required="true" label="Phone" placeholder="Phone" class="form-control text-input" name="text-1579713740814" value="Phone"></field> <field type="text" subtype="text" label="Alternate Phone" placeholder="Alternate Phone" class="form-control text-input" name="text-1579713743540" value="Alternate Phone"></field> <field type="text" subtype="email" required="true" label="Email" placeholder="Email" class="form-control text-input" name="text-1579713790141" value="Email"></field> <field type="select" required="true" label="Cat or Dog?" placeholder="Cat or Dog?" class="form-control select" name="select-1579714217592" multiple="true"> <option value="Cat">Cat</option> <option value="Dog">Dog</option> </field> <field type="text" subtype="text" required="true" label="Pet's Name" placeholder="Pet's Name" class="form-control text-input" name="text-1579713809505" value="Pet's Name"></field> <field type="text" subtype="text" required="true" label="Breed" placeholder="Breed" class="form-control text-input" name="text-1579713837283" value="Breed"></field> <field type="text" subtype="text" required="true" label="Description of pet. (i.e. color, size, etc.)" placeholder="Description of pet. (i.e. color, size, etc.)" class="form-control text-input" name="text-1579714136105" value="Description of pet. (i.e. color, size, etc.)"></field> <field type="select" required="true" label="Sex" placeholder="Sex" class="form-control select" name="select-1579713847834" multiple="true"> <option value="Male">Male</option> <option value="Female">Female</option> </field> <field type="select" required="true" label="Spayed or Neutered?" placeholder="Spayed or Neutered?" class="form-control select" name="select-1579713877713" multiple="true"> <option value="Yes">Yes</option> <option value="No">No</option> </field> <field type="checkbox-group" label="Update Animal Status" class="checkbox-group" name="checkbox-group-1579713909249"> <option value="Deceased">Deceased</option> <option value="Left Municipality">Left Municipality</option> <option value="No Longer Owner" selected="true">No Longer Owner</option> </field> <field type="text" subtype="text" required="true" label="Applicant Signature" description="Please enter your name as a digital signature to authorize that this information is correct." placeholder="Applicant Signature" class="form-control text-input" name="text-1579713960512" value="Applicant Signature"></field> <field type="date" required="true" label="Date" description="Please select current date of application." class="form-control calendar" name="date-1579714077265" value="Date"></field> <field type="paragraph" subtype="p" label="This information is being collected under the authority of the Town of Shellbrook Animal Control Bylaw and in accordance with Part 2 of the Freedom of Information and Protection of Privacy Act. It will be given and / or used strictly in confidence and only as necessary by the Town of Shellbrook, the Town’s Animal Control Contractor/Officer, and the RCMP for the intended purpose of Animal Control and Enforcement. If you have any questions about the collection and intended use of any of this information, please contact the Town of Shellbrook at (306) 747-4900, or in person at the Town Office at 71 Main Street." class="paragraph"></field> </fields> </form-template> Submit Submitting...
