Dog Registration e-Form

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date

Phone

Email

Premises where the dog will be kept

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name

First Last

Emergency Contact Phone

DESCRIPTION OF DOG

Please ensure that all information is correct and all copies of proof is attached

Name of Dog #1

Breed/Type #1

Sex (Male or Female) #1

Is the dog sterilised?

Yes

No

Date of Birth

Colour or perculiar markings

Discounted Fee if paid by June 30, 2024

Fee if paid On or After July 1, 2024

Microchip Number of Dog #1

Do you have another dog to register?

Yes

No

Name of Dog #2

Breed or Type

Sex (Male or Female)

Is the dog sterilised

Yes

No

Date of Birth

Colour or perculiar markings

Discounted Fee if paid by June 30, 2024

Fee if paid On or After July 1, 2024

Microchip Number of Dog #2

Please tick the relevant boxes:(Required)

Dog Ownership Transferred (Must provide new owner name and details in writin)

Desexed (copy of proof MUST be provided)

Owner has become a pensioner (a valid Pension Card must be signed)

Dog has died (provide date below)

Date dog passed away

If any information on this application form is incorrect, you MUST advise by either email to wtc@wtc.tas.gov.au or PO Box 16, Riverside TAS 7250.

Upload any relevant documentation here

Max. file size: 64 MB.

Declaration to be completed

I, THE UNDERSIGNED DECLARE THAT:

For the purposes of section 16 (1) and Section 8 (1) of the Dog Control Act 2000, that at the premises at which the dog(s) will ordinarily be kept there is effective containment for the dog(s) and that the dog is registered.
I am also aware that should my dog be found at large, I am liable for a minimum $195 infringement plus pound fees.
The owner of the dog is over 18 years of age.
I authorise the Council to make any adjustments noted on this form.
The particulars shown on this application are true to the best of my knowledge and beliefs.

Signed (Owner/Agent)(Required)

Date(Required)

Under Section 78 of the Dog Control Act, a person in making any application or giving any information under the Act, must not –
(a) make a statement knowing it to be false or misleading; or,
(b) omit any matter knowing that without that matter the application or information is misleading.

CAPTCHA

Replacement registration tag (includes Transfer of (Tas) Council Registrations)	$14
Annual renewal of kennel licence	$64

Dog Registration Application

DESCRIPTION OF DOG

Declaration to be completed