Dog registration All dogs more than six months of age must be registered. Applicant detailsName*A child’s pet is to be registered in the name of a parent or guardian. Mr.Mrs.MissMs.Dr.Prof.Rev. Title Given names Last name Date of birth - dd/mm/yyyy* DD slash MM slash YYYY Postal address* Street Address Address Line 2 Suburb Post code Mobile number*Home numberBusiness numberEmail How would you like to receive dog registration renewal notices:* I want to receive my dog renewal notice by EMAIL only. I want to receive my dog renewal notice by POSTAGE only. Details of your dogProperty address of dog* Street Address Address Line 2 Suburb Post code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Dog's name* Breed* Colour* Dog's date of birth (if not known, approximate age)* Sex* Microchip number*Microchipping is compulsory for all dogs over 6 months unless an exemption has been granted. Failure to provide microchip number can result in a fine of $181 being issued to you without notice. Required evidenceRegistration class* Desexed dog Entire dog Tasmanian Canine Association (TCA) Member Guard Dog Dangerous Dog (Declared before 1/12/2015) Dangerous Dog (Declared after 1/12/2015) Guide / Hearing Dog Is your dog already registered in another Tasmania Council and fully paid this financial year?* Yes No Proof of registration with another councilPlease upload documentation showing that your dog is registered with another Tasmanian Council and paid in full for this financial year. This registration will be free if evidence of payment can be provided. Drop files here or Select files Max. file size: 100 MB. Certificate of Sterilisation*Please upload a Certificate of Sterilisation from a veterinary surgeon, or other documentation confirming that the dog is sterilised, or the provision of a statutory declaration. Drop files here or Select files Max. file size: 100 MB. Evidence of your TCA membership*Please upload a photo of your current Tasmanian Canine Association membership card. Drop files here or Select files Max. file size: 100 MB. Evidence of guide/hearing dog eligibility*Please upload a photo of evidence of your dogs status as a guide/hearing dog. Drop files here or Select files Max. file size: 100 MB. Are you the holder of a current Concession Card?*A 20% discount to 'Entire' or 'Desexed' dogs are applied to the holders of a current concession card. Cards that are accepted are: *Centrelink Health Care Card *Centrelink or Department of Veteran’s Affairs pension card *Department of Veterans Affairs ‘gold card’ endorsed with TPI or War Widow. Yes No What type of concession card do you have?* Centrelink Health Care card Centrelink or Department of Veteran's Affairs pension card Department of Veterans' Affairs 'gold card' endorsed with TPI or War Widow Card start date - dd/mm/yyyy*The Card Start Date appears on the front of your concession card DD slash MM slash YYYY What is the card number?* Please attach an image of the front of your card.* Drop files here or Select files Max. file size: 100 MB. If you are experiencing difficulty uploading an image you may submit the application without one, and a member of our team will contact you to assist you further.Does your dog have level 4 obedience training?*A 50% discount is applied to 'Entire' or 'Desexed' dogs for those who can produce proof of level 4 obedience training. Yes No Please upload evidence of level 4 obedience training* Drop files here or Select files Max. file size: 100 MB. Do you have a second dog to register? Yes No Details of second dogDog's name* Breed* Colour* Sex* Microchip number*Microchipping is compulsory for all dogs over 6 months unless an exemption has been granted. Failure to provide microchip number can result in a fine of $181 being issued to you without notice. Dog's date of birth (if not known, approximate age)* Required evidence (second dog)Registration class of second dog* Entire dog Desexed dog Tasmanian Canine Association (TCA) Member Guard Dog Dangerous Dog (Declared before 1/12/2015) Dangerous Dog (Declared after 1/12/2015) Guide / Hearing Dog Is your dog already registered in another Tasmania Council and fully paid this financial year?* Yes No Proof of registration with another councilPlease upload documentation showing that your dog is registered with another Tasmanian Council and paid in full for this financial year. This registration will be free if evidence of payment can be provided. Drop files here or Select files Max. file size: 100 MB. Certificate of Sterilisation*Please upload a Certificate of Sterilisation from a veterinary surgeon, or other documentation confirming that the dog is sterilised, or the provision of a statutory declaration. Drop files here or Select files Max. file size: 100 MB. Evidence of your TCA membership*Please upload a photo of your current Tasmanian Canine Association membership card. Drop files here or Select files Max. file size: 100 MB. Evidence of guide/hearing dog eligibility*Please upload a photo of evidence of your dogs status as a guide/hearing dog. Drop files here or Select files Max. file size: 100 MB. Does your dog have level 4 obedience training?*A 50% discount is applied to 'Entire' or 'Desexed' dogs for those who can produce proof of level 4 obedience training. Yes No Please upload evidence of level 4 obedience training* Drop files here or Select files Max. file size: 100 MB. Authorisation and Consent Consent* I agree to the privacy policy.The privacy information on this form is required by Clarence City Council for Dog Control under the Dog Control Act 2000. We will only use your personal information for this and related purposes. If this information is not provided, we may not be able to deal with this matter. You may access and/or amend your personal information at any time. How we use this information is explained in our Privacy Policy, which is available at www.ccc.tas.gov.au or at council offices.In making this application:* Select All I declare that the information I have provided is true and correct I agree that by typing my name below I have signed this application Name of signatory* CommentsThis field is for validation purposes and should be left unchanged.