Dog Registration online form

Owners First Name *

Owners surname *

Street address *

Suburb *

Postcode *

Owners Date of Birth *

Owners contact number *

Owners email address

Alternative Contact Name

Residential address

Contact Number

Email address

Dog's name *

Primary Colour *

Secondary Colour

Breed(s) *

Breed(s)

Age or Date of Birth *

Microchip Number *

Please provide proof of Microchip number *

Gender *

Sterilised *

Please provide proof of sterilisation *

Number of dogs on property

Address where the dog will primarily be kept *

Please confirm the dog use *

Has the dog been declared a dangerous dog? *

If declared dangerous, please provide details.

Do you have any convictions for offences against the Cat Act 2011, Dog Act 1976 or Animal Welfare Act 2002 in the past 3 years? *

If yes, provide details

Do you hold a current Pensioner card? *

Please enter your Pension card number *

Fees Sterilised - Pensioner

Fees - unsterilised- pensioner rate

Fees - unsterilised

Fees payable - Sterlised

I am not, or the Owner is not, under eighteen years of age. The Town of Claremont may refuse an application if any or all of the required information is not provided within the time period required. *

The information provided is true and correct. I am aware it is an offence to provide false information. *

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Dog Registration online form

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