Application To Register Domestic Animal(S)

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Application to Register Domestic Animal(s)
RECEIPT NO.
For year ending 9 April 2017
Under the provisions of the Domestic Animals Act 1994 all dogs and cats over 3 months of
POUND ANIMAL ID
age must be registered. Registration renewals must be paid by 10 April each year.
A person under the age of 18 years must have their dog and /or cat registered
in the name of a parent or guardian.
CIVIC CENTRE - HOURS MON, WED, THUR, FRI - 8.30AM TO 5.00PM. TUES ONLY 8.30AM TO 8.00PM
COUNCIL REFERENCE NO.
511 Burwood Highway, Wantirna South 3152 Phone: 9298 8000
ROWVILLE CUSTOMER SERVICE CENTRE - HOURS MON - FRI 9.00AM TO 5.00PM
Shop 32A Stud Park Shopping Centre Cnr Stud & Fulham Roads, Rowville 3178
OWNERS DETAILS
First Name
Middle Name
Surname
Sex: M/F
Street address
Suburb
Postcode
D.O.B.
/
/
Address where animal(s) is/are kept, if different from above
Telephone No. Mobile
Home/Work
Email Address
Pension Number
Second contact: Name
Phone Number
ANIMAL DETAILS
Animal 1
Animal 2
Animal 3
Animal Type
Dog
Cat
Dog
Cat
Dog
Cat
(tick one box)
Gender
Female
Male
Female
Male
Female
Male
(tick one box)
Desexed
Yes
No
Yes
No
Yes
No
(tick one box)
Proof required
All cats must be desexed before registration will be accepted.
Microchip Number
Proof required
Breed
Colour
Animal's Name
Date of Birth of Animal
Council must not register a dog or cat that has not been implanted with a microchip; this includes
previously registered dogs and cats that move into Knox from another Council.
Restricted Breed Dog
Yes
No
Yes
No
Yes
No
(tick one box)
Declared Dangerous Dog
Yes
No
Yes
No
Yes
No
(tick one box)
Declared Menacing Dog
Yes
No
Yes
No
Yes
No
(tick one box)
Fee $
to be paid with application
Tag No.
A pet wearing a Council tag is never lost
Office use only
DECLARATION
I declare that the dog(s) in this application have been correctly indicated as to whether they are, or are not, of a restricted breed (restricted
breeds are as follow – a Pitbull Terrier or American Pitbull Terrier, Fila Brasilerio, Dogo Argentino, Japanese Tosa or Perro de Presa Canario or
Presa Canario).
I declare that to the best of my knowledge and belief all the above information is true and correct. The Domestic Animals Act 1994 states
“whether the owner of a dog or cat is under the age of 18 years, the parent or guardian of that person is deemed to be the owner” . If the
owner is under 18 years, a parent or guardian must sign on their behalf.
Signature of owner ..................................................................... Name ........................................................................................ Date ....................................................

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