Dog registration application

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1 Dog registration application When to use this form Use this form if you need to register your dog. Once a dog is six months old it must be registered by a person over 18 years old. For further information, including the current fees for dog registration please refer to the City's website Please te, if you are have more than one dog to register, each dog must be registered separately. Owner's details First name Last name address Telephone number After hours telephone number (if different to the number above) Owner's postal address Dog registration application 1 of 16

2 Preferred contact method (Select one option) telephone SMS Australia Post Owner's date of birth D D M M Y Y Y Y Alternative contact details (in case we can't contact you) First name Last name Telephone number Dog details Dog's name Address where dog will be kept Main breed (Select one option) Dog registration application 2 of 16

3 Affenpinscher Afghan Hound Airedale Terrier Akita Alaskan Malamute American Cocker Spaniel American Bulldog American Pit Bull Terrier Anatolian Shepherd Australian Cattle Dog Australian Koolie Australian Kelpie Australian Shepherd Australian Silky Terrier Australian Bulldog Australian Bulldog (miniature) Australian Terrier Basenji Basset Hound Beagle Bearded Collie Bedlington Terrier Belgian Shepherd Bernese Mountain Dog Bichon Frise Bloodhound Blue Heeler Border Collie Border Terrier Borzoi Boston Terrier Bouvier Des Flandres Breama Italian Sheepdog Briard British Bulldog Brittany Spaniel Bull Arab Bullmastiff Bull Terrier Bull Terrier (miniature) Cairn Terrier Cane Corso Cardigan Welsh Corgi Catahoula Cavalier King Charles Spaniel Dog registration application 3 of 16

4 Cavoodle Central Asian Shepherd Chesapeake Bay Retriever Chihuahua Chihuahua Long-Coated Chinese Crested Dog Chow Chow Clumber Spaniel Cocker Spaniel Coton De Tulear Curly Coated Retriever Dachshund Dachshund Smooth Haired Dachshund Smooth Haired (miniature) Dashshund Long Haired Dashshund Long Haired (miniature) Deerhound Doberman Dogue De Bordeaux English Cocker Spaniel English Pointer English Setter English Springer Spaniel English Staffordshire Bull Terrier English Toy Terrier Field Spaniel Finnish Lapphund Finnish Spitz Flat Coated Retriever French Bulldog German Coolie German Pinscher German Shepherd German Shorthaired Pointer German Spitz German Wirehaired Pointer Glen Of Imaal Terrier Golden Cavador Golden Retriever Gordon Setter Grand Basset Griffon Vendeen Great Dane Greyhound Groodle Hamiltonstovare Dog registration application 4 of 16

5 Harrier Havanese Hound Hovawart Hungarian Puli Hungarian Vizla Huntaway Ibizan Hound Irish Setter Irish Terrier Irish Wolfhound Irish Water Spaniel Italian Greyhound Italian Spine Jack Russell Terrier Japanese Chin Japanese Spitz Johnson Bull Dog Kangal Keeshond Kerry Blue Terrier King Charles Spaniel Komondor Labradoodle Labradoodle (miniature) Labrador Retriever Lagotto Lakeland Terrier Large Munsterlander Leonberger Lepagneul Breton Lhasa Apso Lowchen Lundehund Lurcher Maltese Manchester Terrier Maremma Sheepdog Mastiff Munsterlander Neapolitan Mastiff Newfoundland Norwegian Buhund Norwegian Elkhound Norfolk Terrier Dog registration application 5 of 16

6 Norwich Terrier Nova Scotia Duck Tolling Retriever Old English Sheepdog Otterhound Papillon Parson Jack Russell Terrier Pekingese Pembroke Welsh Corgi Petit Basset Griffon Vendeen Pit Bull Terrier Pointer Polish Lowland Sheepdog Pomeranian Poodle (giant) Poodle (standard) Poodle (miniature) Poodle (toy) Portuguese Water Dog Prague Ratter Pug Pugalier Puli Pyrenese Mountain Dog Rhodesian Ridgeback Rottweiler Rough Collie Ryukyu Saluki Samoyed Schipperke Schnauzer (giant) Schnauzer (standard) Schnauzer (miniature) Schodle Scotch Collie Scottish Terrier Soft Coated Wheaten Terrier Sealyham Terrier Sharpei Shetland Sheepdog Shiba Inu Shih tzu Siberian Husky Skye Terrier Sloughi Smithfield Dog registration application 6 of 16

7 Smooth Collie Sodle Spaniel Spoodle Springer Spaniel Staffordshire Bull Terrier Staghound St Bernard Stumpy Tail Cattle Dog Standard Poodle Swedish Vallhund Tenterfield Terrier Terrier Tibalier Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Weimaraner Welsh Springer Spaniel Welsh Corgi Welsh Terrier Whippet West Highland White Terrier Yorkshire Terrier Cross breed (Select one option) Affenpinscher Afghan Hound Airedale Terrier Akita Alaskan Malamute American Cocker Spaniel American Bulldog American Pit Bull Terrier American Staffordshire Terrier Anatolian Shepherd Australian Cattle Dog Australian Coolie Australian Kelpie Australian Shepherd Australian Silky Terrier Australian Bulldog Australian Bulldog (miniature) Dog registration application 7 of 16

8 Australian Terrier Basenji Basset Hound Beagle Bearded Collie Bedlington Terrier Belgian Shepherd Bernese Mountain Dog Bichon Frise Bloodhound Blue Heeler Border Collie Border Terrier Borzoi Boston Terrier Bouvier Des Flandres Breama Italian Sheepdog Briard British Bulldog Brittany Spaniel Bull Arab Bullmastiff Bull Terrier Bull Terrier (miniature) Cairn Terrier Cane Corso Cardigan Welsh Corgi Catahoula Cavalier King Charles Spaniel Cavoodle Central Asian Shepherd Chesapeake Bay Retriever Chihuahua Chihuahua Long Coated Chinese Crested Dog Chow Chow Clumber Spaniel Coton De Tulear Curly Coated Retriever Dachshund Dachshund Smooth Haired Dachshund Smooth Haired (miniature) Dachshund Long Haired Dachshund Long Haired (miniature) Deerhound Dog registration application 8 of 16

9 Doberman Dogue De Bordeaux English Cocker Spaniel English Pointer English Setter English Springer Spaniel English Staffordshire Bull Terrier English Toy Terrier Field Spaniel Finnish Lapphund Finnish Spitz Flat Coated Retriever French Bulldog German Coolie German Pinscher German Shepherd German Shorthaired Pointer Glen Of Imaal Terrier Golden Cavador Golden Retriever Gordon Setter Grand Basset Griffon Vendeen Great Dane Greyhound Groodle Hamiltonstovare Harrier Havanese Heeler Hound Hovawart Hungarian Puli Hungarian Vizla Huntaway Ibizan Hound Irish Setter Irish Terrier Irish Wolfhound Irish Water Spaniel Italian Greyhound Italian Spine Jack Russell Terrier Japanese Chin Japanese Spitz Johnson Bull Dog Dog registration application 9 of 16

10 Kangal Keeshound Kerry Blue Terrier King Charles Spaniel Komondor Labradoodle Labradoodle (miniature) Labrador Retriever Lagotto Lakeland Terrier Large Munsterlander Leonberger Lepagneul Breton Lhasa Apso Lowchen Lundehund Lurcer Maltese Manchester Terrier Maremma Sheepdog Mastiff Munsterlander Neapolitan Mastiff Newfoundland Norwegian Buhund Norwegian Elkhound Norfolk Terrier Norwich Terrier Nova Scotia Duck Tolling Retriever Old English Sheepdog Otterhound Papillon Parson Jack Russell Terrier Pekingese Pembroke Welsh Corgi Petit Basset Griffon Vendeen Pit Bull Terrier Pointer Polish Lowland Sheepdog Pomeranian Poodle (standard) Poodle (miniature) Poodle (toy) Portuguese Water Dog Prague Ratter Dog registration application 10 of 16

11 Pug Pugalier Puli Pyrenese Mountain Dog Rhodesian Ridgeback Rottweiler Rough Collie Ryukyu Saluki Samoyed Schipperke Schnauzer (giant) Schnauzer (standard) Schnauzer (miniature) Schodle Scotch Collie Scottish Terrier Soft Coated Wheatan Terrier Sealyham Terrier Sharpei Shetland Sheepdog Shiba Inu Shih tzu Siberian Husky Skye Terrier Sloughi Smithfield Smooth Collie Sodle Spaniel Spoodle Springer Spaniel Staffordshire Bull Terrier Staghound St Bernard Stumpy Tail Cattle Dog Swedish Vallhund Tenterfield Terrier Terrier Tibalier Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Weimaraner Welsh Springer Spaniel Welsh Corgi Dog registration application 11 of 16

12 Welsh Terrier Whippet West Highland White Terrier Yorkshire Terrier Primary colour (Select one option) Apricot Beige Biscuit Black Blenheim Blonde Blue Brindle Brown Caramel Chestnut Chocolate Copper Cream Crimson Fawn Ginger Gold Grey Honey Lemon Liver Mahogany Orange Red Rust Sandy Seal Silver Tan Tricolour White Wheaten Yellow Dog registration application 12 of 16

13 Secondary colour (Select one option) Apricot Beige Biscuit Black Blenheim Blonde Blue Brindle Brown Caramel Chestnut Chocolate Copper Cream Crimson Fawn Ginger Gold Grey Honey Lemon Liver Mahogany Orange Red Rust Sandy Seal Silver Tan Tricolour Whitw Wheaten Yellow Sex (Select one option) male female Dog registration application 13 of 16

14 Dog's date of birth or approximate age Microchip number Please include an attachment of your dog's microchip details Please attach all files to the end of this form before submitting it. Registration details Are you claiming a pensioner concession? (Select one option) If, you can do this for one dog only. Please te that Health Care Card Holders are t eligible for this concession. Is your dog desexed? (Select one option) If, you will need to show the sterilisation certificate. Is your dog a greyhound? (Select one option) If, you will need to show a Greyhound Suitability Program Certificate. Dog registration application 14 of 16

15 Does your dog have a Level 1 Obedience Training Certificate? (Select one option) If, you will need to show the certificate. Is your dog a declared dangerous/restricted breed? (Select one option) If, your application must go through the City's inspection and approval process. For more information about declared dangerous or restricted breed dogs visit the Tasmanian Government website Is your dog a pure breed? (Select one option) If, a Dogs Tasmania Membership Certificate is required. Is your dog a working dog? (Select one option) If, a Statutory Declaration is required. Is your dog a guard dog? (Select one option) If, a Statutory Declaration is required. Is your dog a guide/assistance dog or puppy walker? (Select one option) If, appropriate documentation or letter is required. Dog registration application 15 of 16

16 Please attach all required supporting documents. Please attach all files to the end of this form before submitting it. Declaration I declare the above information to be true in every respect to the best of my kwledge and belief in accordance with Section 78 of the Dog Control Act I agree to abide by the requirements of the Dog Control Act 2000, and am aware that failure to do so may result in my Dog Registration Application to be refused, or registration of my dog(s) cancelled. Name of signatory Ackwledgment (Select one option) by selecting this I ackwledge that I have signed this application Date D D M M Y Y Y Y For information on how Council manages, handles and protects personal information it collects please refer to the Privacy Statement and Policy End of form Don't forget to attach all files before submitting this form Dog registration application 16 of 16

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