OFFICE USE ONLY

Date: Receipt number: CSO: Information checked: Y / N

Animal 1: $ Tag # issued: Animal 2: $ Tag # issued:

RRC143 – Planning and Regulatory Services | V6 | Approved 28 July 2021 File 11741 –QDAN 480v4 – 19.6.4 – 3 years after expiry of registration

Page 1 of 3

Owner Details (please nominate only one dog owner who must be over 18 years of age) Owner name:

First Middle Last

Are you over the age of 18? ☐ Yes ☐ No Date of birth:

Preferred contact number: Email:

Preferred delivery method: ☐ Email ☐ Post ☐ Collect – (Rockhampton, Gracemere, Mt Morgan) Email is the standard form of delivery. If this method is unsuitable please select an alternative. Postal Address

Street number and name:

Suburb: State: Postcode:

Alternate Contact Details (these details will be used by Council if unable to contact the dog owner)

Name: Contact number:

Pensioner Status Name on card: Card number:

Over 65’s Status (a copy of your seniors card, drivers licence or birth certificate must be provided at time of lodgement)

Name on card: Card number:

Dog Details

Dog 1

Has your dog been registered with Council previously, either in your name or a different name? (if yes, please attach details to this application) ☐ Yes ☐ No

Registration type: ☐ New ☐ Transfer from deceased dog ☐ Transfer from another QLD local government

Name: Reference number: -

Date of birth: Breed: Gender: ☐ Male ☐ Female

Desexed: ☐ Yes ☐ No Microchip number:

Distinguishing features: Colour:

Address where dog is kept (if different to owner):

Please indicate if one of the following classes is applicable (refer to the Dog Registration Factsheet for information and further requirements)

☐ Guide/Assistance dog ☐ Farm dog ☐ Dogs Queensland ☐ Regulated dog

If selected regulated dog, please choose from the following:

☐ Dangerous ☐ Menacing ☐ Restricted (please complete Restricted Dog section)

Privacy Notice: Rockhampton Regional Council is collecting the personal information you supply on this form for the purpose of processing your application. Council is authorised to do this under the Animal Management (Cats and Dogs) Act 2008. Council deals with personal information in accordance with law, including the Information Privacy Act 2009. This form is to be completed when registering your dog/s. All dogs must be registered from 12 weeks of age. Please refer to the Dog Registration Factsheet for further information.

Dog Registration Application Form

RRC143 – Planning and Regulatory Services | V6 | Approved 28 July 2021 File N/A – N/A – QDAN 480 v.4 – 19.6.4 – 3 years

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Dog 2

Has your dog been registered with Council previously, either in your name or a different name? (if yes, please attach details to this application) ☐ Yes ☐ No

Registration type: ☐ New ☐ Transfer from deceased dog ☐ Transfer from another QLD local government

Name: Reference number: -

Date of birth: Breed: Gender: ☐ Male ☐ Female

Desexed: ☐ Yes ☐ No Microchip number:

Distinguishing features: Colour:

Address where dog is kept (if different to owner):

Please indicate if one of the following classes is applicable (refer to the Dog Registration Factsheet for information and further requirements)

☐ Guide/Assistance dog ☐ Farm dog ☐ Dogs Queensland ☐ Regulated dog

If selected regulated dog, please choose from the following:

☐ Dangerous ☐ Menacing ☐ Restricted (please complete Restricted Dog section)

Restricted Dog (please complete this section if your dog is one of the below breeds to apply for a Restricted Dog Permit)

Restricted breed:

☐ American Pit Bull Terrier/Pit Bull Terrier ☐ Fila Brasileiro ☐ Dogo Argentino

☐ Perro de Presa Canario/Presa Canario ☐ Japanese Tosa

Type of shelter: ☐ Detached house ☐ Garage/carport ☐ Other:

Is the premises fully fenced: ☐ Yes ☐ No Number of entry points:

Type of fence: Height of fence:

Declaration

I submit this Dog Registration Application Form with the relevant supporting documentation as required. I declare that the details are correct to the best of my ability. I am aware that, I, the applicant must be the responsible person for the dog/s and that the number of dogs kept at the property is in accordance with the allowable number of dogs (if more than two dogs are kept at this property an Additional Animal/s Approval Application Form must accompany this form).

Name: Signature: Date:

Supporting Documentation Please remember to provide the following supporting documentation when submitting this form (if applicable): ☐ Desexing certificate (if you are unable to provide, a completed statutory declaration will be accepted)

☐ Microchip certificate/sticker

☐ Guide, hearing and assistance handlers identification card

☐ Membership certificate from Dogs Queensland

☐ Proof registration with another local government (Queensland only)

☐ Death certificate or registration tag (if you are unable to provide, a completed statutory declaration will be accepted)

☐ Recent colour photo of the dog (only required if applying as a restricted dog)

☐ Seniors card, driver’s licence or birth certificate

RRC143 – Planning and Regulatory Services | V6 | Approved 28 July 2021 File N/A – N/A – QDAN 480 v.4 – 19.6.4 – 3 years

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Fees and Charges For a full list of fees and charges please refer to Council’s Fees and Charges Schedule.

Payment Information In person | You can pay at Council’s Customer Service Centres: 232 Bolsover Street, Rockhampton; 32 Hall Street, Mount Morgan; 1 Ranger Street, Gracemere. By phone | Customer Service staff will contact you regarding payment via credit card or debit once this form is received. By post | Make your cheques/money order payable to ‘Rockhampton Regional Council’ and send to PO Box 1860, Rockhampton, Queensland, 4700.

P: 07 4932 9000 or 1300 22 55 77E: enquiries@rrc.qld.gov.au W: www.rrc.qld.gov.au

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Rockhampton Regional CouncilPlanning & Regulatory Services

Why register your dog?It’s the law. Dogs aged 12 weeks and over must be registered and microchipped.

Registering your dog improves their chances of being safely returned to you if they are lost.

Dog registration also helps Council: • provide activities for you and your dog, including

dog parks and exercise facilities,• investigate and resolve dog problems.

A maximum of two dogs can be kept on a property of any size - approval is required for additional dogs.

Guide/Assistance DogsPeople who are blind, visually impaired or living with a disability receive free registration for guide/assistance dogs. You must submit a dog registration application form and a copy of your:• guide, hearing, assistance handlers identification

card,• appropriate handlers identification card.

Farm DogsFarm dog registration applies to pet dogs on rural land and/or land that is 20,000m2 or larger and the owner must be a primary producer.

Evidence of the owner being a primary producer must be provided at the time of registration. Farm dogs do not include working dogs.

Dog RegistrationDogs can make wonderful companions and bring much joy and happiness to their owners. Owning a dog however does bring many responsibilities. One of those responsibilities includes their registration.

P: 07 4932 9000 or 1300 22 55 77E: enquiries@rrc.qld.gov.au W: www.rrc.qld.gov.au

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Rockhampton Regional CouncilPlanning & Regulatory Services

Regulated Dogs Regulated dogs include Restricted, Declared Dangerous or Declared Menacing dogs. Higher registration fees apply to regulated dogs.

A restricted dog is one of the following breeds: American Pit Bull Terrier or Pit Bull Terrier, Fila Brasilerio, Dogo Argentino, Japanese Tose and Perro de Presa Canario or Presa Canario.

Dogs QueenslandMembers of Dogs QLD receive reduced registration fees. Evidence of membership must be provided at the time of registration to be eligible for the reduced rate.

Transfer from deceased dog A dog owner may transfer the remaining registration for a deceased dog to a new dog within the same registration period only. A Dog Registration Application Form must be completed and notification of the deceased dog attached.

Reciprocal Registration Council will honour registration paid for the same period to another Queensland Local Government. Proof of registration with another Queensland Local Government is to be provided at the time of registering with Rockhampton Regional Council.

Refunds Refunds are only payable to the person who paid the dog registration. For claims received from 1 September to 28 February Council will refund: • 50% of the registration fee for deceased dogs. The

owner must provide proof.• The difference between the ‘entire’ and ‘desexed

fees’, if the dog is desexed during the registration period. The owner must provide proof of desexing.

• The difference between the ‘desexed’ fee and the ‘desexed and microchipped’ fee, where the desexed dog is microchipped during the registration period. The owner must provide proof of microchipping.

• The difference between the ‘entire’ and ‘desexed and microchipped’ fees, where the dog is desexed and microchipped during the registration period. The owner must provide proof of desexing and microchipping.

• The difference between the ‘full registration’ and ‘pension concession fee’, if the owner becomes a pensioner during the registration period. The owner must provide proof on concession entitlement.

Council does not refund for relocated dogs outside of the Rockhampton Region however, the owner may be eligible for reciprocal registration in their new local government area.

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