Township of Nutley
Department of Public Affairs and Health
Mayor John V. Kelly, III

Rabies Vaccination Pre-Registration

Please fill out the below form to pre-register and
receive your Rabies Vaccination Certificate Pre-Filled for
presentation at the clinic to be signed by the veterinarian

TOWNSHIP OF NUTLEY
FREE RABIES IMMUNIZATION CLINIC

CHESTNUT ST. FIREHOUSE
228 Chestnut Street, Nutley

MONDAY, APRIL 13, 2026
4:00 - 7:30 PM

Bring your dog properly leashed and your cat in a proper carrier to the Firehouse located at 228 Chestnut Street for protection against this fatal disease. This is 3-year vaccination for dogs and cats.

The State Department of Health is encouraging the vaccination of cats to help prevent the spread of rabies. Our department will provide free vaccinations for cats at these clinics.

As of January 2005, it is now required to procure a license for your cat(s). A valid vaccination certificate is necessary to obtain the license.

Dog/Cat licenses may be purchased during clinic hours after presentation of valid vaccination certificates.

Owner's Name*

Last NameFirst Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

DogCat

Pet's Name*

Predominant Breed*

Colors*

MaleFemale

YesNo

3 - 12 Months12 Months or Older

Under 20 Lbs.20 - 50 Lbs.Over 50 Lbs.

Producer

3-Yr. Lic/Vacc.

Vaccine Serial No.

Veterinarian's Name

Veterinarian's Address

Date Vaccinated

MonthDayYear

Vaccination Expires

MonthDayYear

Township of Nutley
Department of Public Affairs and Health
Mayor John V. Kelly, III

Rabies Vaccination Pre-Registration

Owner's Information

Pet Information

Township of NutleyDepartment of Public Affairs and HealthMayor John V. Kelly, III

Rabies Vaccination Pre-Registration

Owner's Information

Pet Information

Township of Nutley
Department of Public Affairs and Health
Mayor John V. Kelly, III