Application for Registration of Domestic Animal(s)

In accordance with the Domestic Animals Act 1994, all cats and dogs three months or older must be registered. A dog or a cat being registered for the first time must be microchipped. The owners of adog or cat who fail to register their animal may be liable to an infringement of two (2) penalty units.This application for registration must be completed by a person over the age of 18.

ENQUIRIES: 03 5320 5500WARNING: IT IS A PUNISHABLE OFFENCE TO PROVIDE FALSE INFORMATION IN THIS APPLICATION

Owner’s DetailsSurname:

Full Given Names:

Address:

Postcode:

Telephone No: (Home) (Work)

Mobile: Email:

Address where animal is kept if different from above: Do you already have an animal registered with the City of Ballarat?

Yes No

A permit must be obtained to keep more than two (2) dogs or two (2) cats per residential premises.

PAYMENT OPTIONS

MAIL IN PERSONCity of Ballarat, The Phoenix,P.O. Box 655 25 Armstrong Street SouthBallarat VIC 3353 Ballarat Central

Animal 1 Animal 2 Animal 3

Animal Type (tick one box) Dog Cat Dog Cat Dog Cat

Sex (tick one box)

Desexed (proof required) (tick one box)

Female Male

Yes No

Female Male

Yes No

Female Male

Yes No

Breed

Colour / Marks

Animal’s Name

Microchip Number (proof required)

Date of Birth of Animal

Animal(s) Details

Application for egistration of Domestic Animal(s)

In accordance with the Domestic Animals Act 1994, all cats and dogs three months or older must be registered. A dog or a cat being registered for the first time must be microchipped. The owners of adog or cat who fail to register their animal may be liable to an infringement of 2 penalty units. If an owner is under the age of 18, the parent or guardian of that person is deemed to be the owner

ENQUIRIES: 03 5320 5500

Animal(s) Details

Animal Type (tick one box)

Sex (tick one box)

Desexed (proof required) (tick one box)

Breed

Colour/Marks

Animal’s Name

Microchip Number

Date of Birth of Animal

Animal 1 Animal 2 Animal 3

Dog Cat

Female Male

Yes No

Cat

Male

Yes

Dog

Female

No

Dog Cat

Female Male

Yes No

Registration Category/Fee

ID Marker Number(tag number)

Certificate of Sterilisation(or approved association membership)

Pension Card No.

Office Use Only

Owner’s DetailsSurname:

Full Given Names:

Address:

Postcode:

Telephone No: (Home) (Work)

Mobile:

Address where animal is kept if different from above: Do you already have an animal registered with this council?

Yes

No

A Permit must be obtained to keep more than 2 dogs or 2 cats per residential premises.

MAIL IN PERSON

The Phoenix, 25 Armstrong Street South

Ballarat CentralP.O. Box 655

Ballarat VIC 3353

PAYMENT OPTIONS

Email:

and must sign this application on their behalf.

(proof required)

I declare that the dog(s) on this application have been correctly identified as to whether they are, or are not, of a restricted breed.[Restricted breeds are as follows - American Pit Bull Terrier (or Pit Bull Terrier), Fila Brasileiro, Dogo Argentino, Japanese Tosa or Perro de Presa Canario.]I also declare that all the information contained in this application is true and correct and I make it on the understanding that a

Name: .................................................... Signature: ............................................................... Date: ....................................

DECLARATION FOR OWNER (over 17) or PARENT/GUARDIAN

person supplying false information is liable to prosecution under the Domestic Animals Act 1994

WARNING: IT IS A PUNISHABLE OFFENCE TO PROVIDE FALSE INFORMATION IN THIS APLICATION

Application for egistration of Domestic Animal(s)

In accordance with the Domestic Animals Act 1994, all cats and dogs three months or older must be registered. A dog or a cat being registered for the first time must be microchipped. The owners of adog or cat who fail to register their animal may be liable to an infringement of 2 penalty units. If an owner is under the age of 18, the parent or guardian of that person is deemed to be the owner

ENQUIRIES: 03 5320 5500

Animal(s) Details

Animal Type (tick one box)

Sex (tick one box)

Desexed (proof required) (tick one box)

Breed

Colour/Marks

Animal’s Name

Microchip Number

Date of Birth of Animal

Animal 1 Animal 2 Animal 3

Dog Cat

Female Male

Yes No

Cat

Male

Yes

Dog

Female

No

Dog Cat

Female Male

Yes No

Registration Category/Fee

ID Marker Number(tag number)

Certificate of Sterilisation(or approved association membership)

Pension Card No.

Office Use Only

Owner’s DetailsSurname:

Full Given Names:

Address:

Postcode:

Telephone No: (Home) (Work)

Mobile:

Address where animal is kept if different from above: Do you already have an animal registered with this council?

Yes

No

A Permit must be obtained to keep more than 2 dogs or 2 cats per residential premises.

MAIL IN PERSON

The Phoenix, 25 Armstrong Street South

Ballarat CentralP.O. Box 655

Ballarat VIC 3353

PAYMENT OPTIONS

Email:

and must sign this application on their behalf.

(proof required)

I declare that the dog(s) on this application have been correctly identified as to whether they are, or are not, of a restricted breed.[Restricted breeds are as follows - American Pit Bull Terrier (or Pit Bull Terrier), Fila Brasileiro, Dogo Argentino, Japanese Tosa or Perro de Presa Canario.]I also declare that all the information contained in this application is true and correct and I make it on the understanding that a

Name: .................................................... Signature: ............................................................... Date: ....................................

DECLARATION FOR OWNER (over 17) or PARENT/GUARDIAN

person supplying false information is liable to prosecution under the Domestic Animals Act 1994

WARNING: IT IS A PUNISHABLE OFFENCE TO PROVIDE FALSE INFORMATION IN THIS APLICATION

DECLARATION FOR OWNERI declare that the dog(s) on this application have been correctly identified as to whether they are, or are not, of a restricted breed.[Restricted breeds are as follows - American Pit Bull Terrier (or Pit Bull Terrier), Fila Brasileiro, Dogo Argentino, Japanese Tosa orPerro de Presa Canario.]I also declare that all the information contained in this application is true and correct and I make it on the understanding that aperson supplying false information is liable to prosecution under the Domestic Animals Act 1994

Name: .................................................... Signature: ............................................................... Date: ....................................

Office Only

Registration Category/Fee

ID Marker Number (tag number)

Certificate of Sterilisation (or approved association membership)

Pension Card No.

Application for egistration of Domestic Animal(s)

In accordance with the Domestic Animals Act 1994, all cats and dogs three months or older must be registered. A dog or a cat being registered for the first time must be microchipped. The owners of adog or cat who fail to register their animal may be liable to an infringement of 2 penalty units. If an owner is under the age of 18, the parent or guardian of that person is deemed to be the owner

ENQUIRIES: 03 5320 5500

Animal(s) Details

Animal Type (tick one box)

Sex (tick one box)

Desexed (proof required) (tick one box)

Breed

Colour/Marks

Animal’s Name

Microchip Number

Date of Birth of Animal

Animal 1 Animal 2 Animal 3

Dog Cat

Female Male

Yes No

Cat

Male

Yes

Dog

Female

No

Dog Cat

Female Male

Yes No

Registration Category/Fee

ID Marker Number(tag number)

Certificate of Sterilisation(or approved association membership)

Pension Card No.

Office Use Only

Owner’s DetailsSurname:

Full Given Names:

Address:

Postcode:

Telephone No: (Home) (Work)

Mobile:

Address where animal is kept if different from above: Do you already have an animal registered with this council?

Yes

No

A Permit must be obtained to keep more than 2 dogs or 2 cats per residential premises.

MAIL IN PERSON

The Phoenix, 25 Armstrong Street South

Ballarat CentralP.O. Box 655

Ballarat VIC 3353

PAYMENT OPTIONS

Email:

and must sign this application on their behalf.

(proof required)

I declare that the dog(s) on this application have been correctly identified as to whether they are, or are not, of a restricted breed.[Restricted breeds are as follows - American Pit Bull Terrier (or Pit Bull Terrier), Fila Brasileiro, Dogo Argentino, Japanese Tosa or Perro de Presa Canario.]I also declare that all the information contained in this application is true and correct and I make it on the understanding that a

Name: .................................................... Signature: ............................................................... Date: ....................................

DECLARATION FOR OWNER (over 17) or PARENT/GUARDIAN

person supplying false information is liable to prosecution under the Domestic Animals Act 1994

WARNING: IT IS A PUNISHABLE OFFENCE TO PROVIDE FALSE INFORMATION IN THIS APLICATION

For year ending 10 April 2017

LOST TAG If your pet has lost its registration tag, a new one may be obtained at The Phoenix, 25 Armstrong Street South, Ballarat.A fee of $2.50 may be charged for this service.

PENSIONERS If you hold a Pensioner Concession Card, you are entitled to a 50% reduction in fees, except for category D10.Please note: Health Care Cardholders are not eligible for a reduction in fees.

DOCUMENTATION To establish that you are entitled to register your animal(s) at a reduced rate, you must produce thefollowing documentary evidence at time of payment: A pension card Current registration issued by an approved association A certificate from an approved obedience training Body Statutory Declaration or proof of working dog status Certificate of Sterilisation

No.______________________No.______________________No.______________________

Privacy Notification:- The information provided on this form is subject to Section 18 of the Domestic Animals Act1994. The information will only be disclosed as permitted by law, and in accordance with City of Ballarat policy.

Cat Curfew

In what areas must I collect my dog’s faeces?• In any park or reserve• In a road reservation that contains a constructed footpath or

maintained nature strips

• Any walking path or shared footpath• Any public place

REGISTRATION FEES

Category Description FeeCode

D1 A desexed and microchipped dog $36D2 A dog 10 years old $41D3 A dog kept for breeding at a registered domestic animal business $41D4 A dog registered with an approved association of which the owners are a member $41D5 A dog that has undergone approved training as per Regulations $41D6 A dog kept for a working stock (Primary Production) $41 D8 A dog that is not in the above categories $170D9 A dog that is microchipped and desexed up to six (6) months age (initial registration ONLY) $0D10 Dangerous Dog/Restricted Breed Dog/Declared $205 Menacing Dog. (pensioner discount not applicable)

Category Description FeeCode

C1 A desexed and microchipped cat $36C2 A cat over 10 years old $36

C3 A cat kept for breeding at a registered domestic animal business $36

C4 A cat registered with an approved association of which the owner is also a member $36

C6 A cat that is not in the above categories) $155C7 A cat that is microchipped and desexed up to six (6) months age (initial registration ONLY) $0

• State Government Levy: The State Government Levy of $3.50 per dog registration and $2 per cat registration is primarily used to fund responsible pet ownership educational programs. The levy is included in the registration fee.

Control of Dogs All dogs whilst in a public place must be on a leash, cord or chain

unless the dog is in a designated Off-Leash Area.

Designated Dog Off-Lead Areas• Charles Edward Brown Reserve (North West corner opposite

Netball Centre at 238 Dowling Street, Wendouree;Pioneer Park at 5 McKenzie Drive, Wendouree;Cuthberts Road Reserve at 164A Cuthberts Road, Alfredton;Victoria Park at Russell Street, Newington;Gregory St Reserve, 514 & 520 Gregory Street, Soldiers Hill;Chisholm Reserve at CA 13A Chisholm Street, Black Hill;Birdwood Park at CA 72A Midland Highway, Buninyong;M R Power Reserve at 182-198 Grant Street, Sebastopol; andCanadian Lakes Reserve at 815 Geelong Road, Canadian (offCanadian Lakes Boulevard).

• •

• • • • • •

Dogs in Designated Off-Leash Area: A dog may be exercised off a chain, cord or leash in a Designated

Off-Leash Area if the person in apparent control of the dog: a) carries a chain, cord or leash sufficient to bring the dog under effective control; b) remains in effective voice or hand control of the dog and within constant sight of the dog at all times; and c) does not allow the dog to worry, cause a nuisance or threaten any person or animal.If a dog is off a chain, cord or leash in a Designated Off-Leash Areait must be brought under effective control by means of a chain,cord or leash if the dog is within 50m of: a) the arena or ground of an organised sporting or practice event; b) a children’s play equipment area; c) the principal location of an organised public meeting or event; and d) a permanent barbecue or picnic area.If a dog is off a chain, cord or a leash in a Designated Off-Leash Area it must be brought under effective control by means of a chain, cord or leash if the dog is within 10m of any shared path, walking track or waterway.

• Cats must be confined to owner’s premises at night betweensundown and sunrise.