PREREGISTER TODAY! Pre-Registration Form Pre-Register to save time in an emergency situation. Your Pre-Registered information will be available to our staff at the ACART receiving station. Be sure to register with an email address that you will have access to during an emergency. Would you like to Preregister Now? Yes No Who is completing this form? Animal Owner ACART Staff Date What county do you reside in? * AmadorCalaverasEl DoradoNevadaPlacerOther What county do you reside in? Please return to this page when you are ready to Preregister. – Thank you. Create Username and Password Email * Enter Email Create ACART Account Password * Eight characters minimum One lowercase letter One uppercase letter One number One special character Show Passwords Animal(s) Owner #1 First Name (O1) Last Name (O1) Owner #1 Owner #1 First First Last Last Owner #1 – Contact Phone Owner #1 – Alternate Phone First Name (O1) Last Name (O1) Would you like to add a second owner? * Yes No Animal(s) Owner #2 First Name (O2) Last Name (O2) Owner #2 Owner #2 First First Last Last Owner #2 – Contact Phone Owner #2 – Alternate Phone Owner #2 Email (if different) Enter Email Owner’s Address Physical Address * Physical Address Physical Address Physical Address City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Zip My Physical & Mailing Address are the same. Yes No Mailing Address – if different than physical address Mailing Address – if different than physical address Mailing Address – if different than physical address Mailing Address – if different than physical address City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Zip Emergency Contact Person (if you are not reachable) Emergency Contact Person Emergency Contact Person First First Last Last Emergency Contact Phone Emergency Contact Person Email Enter Email Tell us about your animals… How many of each of the animals listed below do you have? Dog Cat Equine Sheep/Goat Llama/Alpaca Pig/Hog Cattle Bird Rodent Rabbit Other animals not listed above, enter type and quantity. Before registering, please confirm that the information you provided above is correct. You will receive a confirmation of your registration via email. Please be sure to check your Spam folder if it does not arrive in your email Inbox. If you are human, leave this field blank. Register