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2. First Name
3. Last Name
4. Phone Number
5. E-Mail Address
7. Date and Time Incident Occurred
   Date and Time Incident Occurred

   Date and Time Incident Occurred
8. Type Of Complaint

   1. Serious dog fight - injuries, no vet bill
   2. Serious dog fight - injuries, vet bill
   3. Serious dog fight - injuries, to human
   4. other
9. If "other", please explain
13. Witness' Information
15. Witness' first name
16. Witness' last name
17. Witness' phone number
18. Witness' email
20. Witness' first name
21. Witness' last name
22. Witness' phone number
23. Witness' email
27. Humans/Dogs Involved
29. Owner's First Name
30. Owner's Last Name
31. Phone Number*
32. Email*
34. Dog's Name
35. Dog's Breed
36. Dog's Color
38. Owner's First Name
39. Owner's Last Name
40. Phone Number*
41. Email
43. Dog's Name
44. Dog's Breed
45. Dog's Color
47. Describe Incident*
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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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