Application for Dog/Cat Registration Privacy Statement The Town is collecting your personal information for the purpose of responding to your request. Some of the information may be provided to the Town's contractors for the purpose of addressing your request. Your information will not be provided to any other person or agency unless you have given us permission, or where legally obligated to do so. If you would like to know more about how the Town handles your personal information, please see the Town's Privacy Statement and Collection Notice. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Please complete this form to register your pet. Full Name of Owner*This field is required. * Required Field. Address of Animal*This field is required. * Required Field. Pensioner Number Contact Phone Number Email Address*This field is required. * Required Field.* Please enter email address Name of Pet*This field is required. * Required Field. Type of Pet*This field is required. DogCat Sex of Pet*This field is required. MaleFemale Colour*This field is required. * Required Field. Sterilised*This field is required. YesNo Proof of Sterilisation - Upload a File here Max File Size: 10.00 MB Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx Age of Pet*This field is required. * Required Field. Microchip Number All dog/cats must be microchipped. You must provide a copy of their current national database microchip certificate in the owner's name. If the microchip is registered to a different name, a transfer of ownership with the database company that the microchip is registered is required before proceeding with this application. If you are unsure which database your pet's microchip is registered to or where to find the certificate, please contact the person or organisation you purchased the pet from.*This field is required. * Required Field. Proof of National Microchip Database Certificate - Upload a file here*This field is required. Max File Size: 10.00 MB Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx Breed*This field is required. * Required Field. Is the dog declared a dangerous dog? YesNoNot Applicable If your dog is a dangerous dog, please submit details in writing Unsterilised Male or Female Dog/Cat - Standard Fees 1 Year - $503 Years - $120Life - $250 Sterilised Male or Female Dog/Cat - Standard Fees 1 year - $203 Years - $42.50Life - $100 Unsterilised Male or Female Dog/Cat - Pensioner Fees 1 year - $253 Years - $60Life - $125 Sterilised Male or Female Dog/Cat - Pensioner Fees 1 year - $103 Years - $21.25Life - $50 Dog Transfer*This field is required. YesNo If Yes (a) which Council? and (b) What is the registration number from the other Council?: * * Required Field. Current Registration Certificate from the other Council Max File Size: 10.00 MB Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx I declare that*This field is required. I am/the owner is not under eighteen (18) years of age; and The particulars on this application are true to the best of my knowledge and belief. For the purpose section 16 (1a) of the Dog Act that the means exist on the premises at which the dog will ordinarily be kept for effective confining the dog within those premises. I agree that once my application has been assessed and an email of approval from the Town has been received, I will contact the Town to make payment*This field is required. Yes Type the code from the image: The code you entered is not valid. Get Audio CodeType the code from the image