Registration of a dog

Dog owner information

Full Name

Date of Birth

Date of Birth: Day

Date of Birth: Month

Date of Birth: Year

Street Address

Postal Address

Phone (Home)

Phone (Mobile)

Phone (Business)

Do you authorise City of Palmerston to disclose your contact information to third parties for animal management and relocation purposes, to assist in the prompt return of your dog?

Yes

Do you provide permission to be contacted via email or SMS in matters relating to your dog/s or registrations?

Yes

City of Palmerston offer discounted rates for some concession cards.

Please upload a clear copy of the front and rear of the card

One file only.
10 MB limit.
Allowed types: jpg, jpeg, webp, png, heif, heics.

Secondary Contact

This may assist in the safe return of your dog.

Secondary Contact Full Name

Secondary Contact Phone

Your dogs information

Dog

Dog
Dog Name Microchip Number Breed Gender Male Female Is your dog de-sexed Yes No If the dog is de-sexed please provide the relevant supporting documentation when submitting this form Upload supporting documentation One file only. 10 MB limit. Allowed types: jpg, jpeg, png, doc, docx, pdf. Transfer of dog registration from other NT council Please upload a copy of the registration certificate. One file only. 10 MB limit. Allowed types: jpg, jpeg, png, doc, docx, pdf. Age Colour Markings At what address is the dog usually kept at? Same as dog owners street address Other… Enter other… Has the dog previously been or is it currently a Declared Dangerous Dog in any other municipality? Yes No Which Council? When? Further details Has the dog been involved in any dog attack/menace incident? Yes No Which Council? When? Further details

Important Information

When upon a public place the animal is to be under the control of a competent person, and there is a requirement for the dog to be retained by leash, cord, chain or similar device.
It is requested that your dog wears its current identification tag issued by City of Palmerston to help assist in its return if your dog becomes lost.
If the dog owner is under the age of 17, a parent or guardian must sign this form as a joint owner.
A person who is registering the dog on behalf of its owner is required to show that authority in writing and attach a copy to this application.

Declaration

I declare the information contained in my application is true and correct. I understand that it is an offence for a dog to be at large, to attack or menace a person or another animal or to cause a nuisance by continually barking. I understand that registration of my dog can be cancelled at any time if Council believes, on reasonable grounds, that the dog is destructive, dangerous, savage or a threat to the safety of our community. Please note that it is an offence to make a false statement or declaration.

Signature of Applicant

Sign above

The Registrar may refuse the registration of an animal pursuant to By-Law 7 (3). Owners of an animal that the Registrar has refused registration of, will be notified in writing and their money refunded. Such an animal must be removed from the municipality.

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