Municipal Building
135 Haddon Avenue
Haddon Township, NJ 08108		

Tele: (856) 854-1176
Fax: (856) 854-9561
Web: www.haddontwp.com	

______ NEW               _______RENEWAL

BACKYARD CHICKEN APPLICATION FORM

The Township of Haddon has licensing requirements for residents desiring to participate in the Backyard Chicken Program.

Applicant Information:

Name: ____________________________________________________________________________________
	First				Middle				Last

Current Address: ______________________________________________________
		     Street 					City/Municipality
		    ______________________________________________________
		     State					Zip

Home Phone:______________________________

Primary Participant’s Name:______________________________________________

Cell Phone Number:______________________  E-Mail Address:___________________________ 

Secondary Adult in the Household’s Name:_____________________________________________

Cell Phone Number:______________________  E-Mail Address:____________________________ 

Applicants must answer the following questions:

Have you ever owned back yard chickens?   ____ YES      ____ NO

	If yes, please explain___________________________________________________________

___________________________________________________________________________________ 

____________________________________________________________________________________

How many chickens do you plan to own?______________________ 

By Agreeing to participate in the Program, the Applicant acknowledges that they have read the attached Ordinance and that their property meets the requirements.  They acknowledge that they may not begin raising hens until they complete the required class.  They agree to meet with a member of the Backyard Chicken Advisory Board prior to submitting application.  Should they at any time desire to withdraw from the Program, or if a rooster is unintentionally purchased, they will inform a member of the Backyard Chicken Advisory Board so that their hens or rooster can be humanely re-homed.

COST:  $10.00 Application Fee due at sign-up and yearly thereafter

SIGNATURE OF PRIMARY APPLICANT:________________________________________ 

SIGNATURE OF SECONDARY APPLICANT:______________________________________ 

…………………………………………………………………………………………………………… 

FOR OFFICIAL USE ONLY

VERIFICATION OF ATTENDANCE AT MANDATORY CLASS:___________________________ 

DATE AND LOCATION OF CLASS:___________________________________________________ 

VERIFICATION AND DATE OF INTERVIEW WITH APPLICANT:__________________________

___________________________________________________________________________________ 

APPROVAL TO PARTICIPATE IN PROGRAM:___________________________________________ 

SIGNATURE OF MEMBER OF THE BACKYARD CHICKEN ADVISORY BOARD:____________ 

___________________________________________________________________________________ 

APPLICATION FEE RECEIVED:_______________________

Please Note:  

Attached is Ordinance #1375 and revised Ordinance #1388 on the Township website at www.haddontwp.com which provides additional information on the rules and regulations for participating in the Backyard Chicken Program.