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Form
Registration of a dog
Dog owner information
Full Name
Date of Birth
Date of Birth: Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Date of Birth: Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Date of Birth: Year
Year
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
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1996
1995
1994
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1991
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1931
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1929
1928
1927
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1925
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1923
1922
1921
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1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Street Address
Postal Address
Phone (Home)
Phone (Mobile)
Phone (Business)
Email
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
No
Do you provide permission to be contacted via email or SMS in matters relating to your dog/s or registrations?
Yes
No
City of Palmerston offer discounted rates for some concession cards.
?
- None -
NT Seniors card
National Seniors Australia Card
NT Concession and Recognition Scheme
Australian Government Pensioner Concession Card (must have DSP, AGE or CA Printed)
DVA Pensioner Concession Card (must have Department of Veteran Affairs printed on card)
DVA Gold Card
DVA White Card
Please upload a clear copy of the front and rear of the card
One file only.
10 MB limit.
Allowed types: jpg, png, pdf, doc, docx.
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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Financial Hardship Arrangements
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Rates Certificates
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Forms
Frequently Asked Questions
Waste Management
Recycling
Street Cleaning
Waste Management Facility
Animals
Dogs at Large
Animal Management By-Law Review
Dog Attack
Dog Registration
Microchipping and Desexing Scheme
Barking Dogs
Caring for Pets
Council Pound
Dog Park
Feral Cat Management
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Where We Live Matters
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Suburbs
Upgrades to streets and roads
Water
Streets and Roads
Parking
Abandoned Vehicles
Driveways
Trees
Irrigation
Maintaining properties and verges
Lights
Secured Drainage Pit Register
Environment
Crocodile Sighting
Cyclone Preparation
Home Composting Rebate Program
Composting
Councils renewable energy
Pest and Weeds
Reserves and Waterways
Mitchell Creek
Palmerston Escarpment
Palmerston Lakes
Prescribed Burns