New Dog and Cat registration form
+This form is for the initial registration of a dog or cat within Loddon Shire, renew forms are sent out by Council annually
Applicant Details
Surname:
Given/ Christian Name:
Street:
Town:
State:
Postcode:
Phone Numbers:
Work:
Home:
Mobile:
Email
*Please note Health Care Card is
not acceptable.
Pension Number(if applicable)*
Address at which animal is kept (if different to above)
Street Number:
Street
Township/Parish:
Please read reverse of registration form for payment and restricted breed declaration
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All cats and dogs must be registered by law, immediately they turn three months of age.
Owners of a dog or cat who fail to register their animal are liable to a fine of not more than 10 penalty units
After 1 May 2007, Council must not register a dog or cat that has not been implanted with a microchip, including
previously registered dogs and cats that move into Loddon from another area. This does not include animals that have
already been registered in Loddon Shire prior to this date.
A permit is required pursuant to Local Law No 4 to keep more than two dogs and/or two cats in a residential or rural
residential area.
This registration period expires on 9th April each year
Pet details
 Dog
 Cat
Age
Animal’s Name
Gender
Male Female
Breed
Desexed
 Yes  No
Colour
Microchip Number
Fee
See note 1
See Note 2
Reg Tag No.
(office use)
Male Female
Desexed
 Dog
 Cat
Animal’s Name
Age
Gender
Breed
 Yes  No
Colour
Microchip Number
Fee
See note 1
See Note 2
Reg Tag No.
(office use)
Note 1: Please affix microchip sticker in space provided
Note 2: Please review Council’s Fees and Charges as published on our web site, for assistance please contact our office.
To register more than 2 animals please print this page again.
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New Dog and Cat registration form
Restricted breed dogs – IMPORTANT NOTICE
The State Government has made significant amendments to the Domestic Animals Act 1994 in relation to the
keeping of “Restricted Breed Dogs”. A “Restricted Breed Dog” means a dog of a breed whose importation into
Australia is prohibited under the Commonwealth “Customs (Prohibited Imports) Regulations 196. These breeds
currently are:
 PIT BULL TERRIER OR PIT BULL TERRIER CROSS
 DOGO ARGENTINO
 FILA BRASILEIRO
 JAPANESE TOSA
 PERRO DE PRESA CANARIO OR PRESA CANARIO
I,
of
 declare that I am the owner of a “Restricted Breed Dog” being a:
 declare that I am NOT the owner of a “Restricted Breed Dog”
And I make this statement conscientiously believing the same to be true and by virtue of the provision of Section
10(3) of the Domestic Animals Act 1994, understand that a person who in any application for registration fails to
complete this declaration shall be guilty of an offence and liable to a penalty not exceeding 10 penalty units
Applicants Signature
Signature: ________________________________________________________________ Date: ________________
* parent or guardian to sign if owner is under 18 years of age.
Payment Method
☐ Cash Payments can be made in our Wedderburn office (please do not send cash in the mail)
☐ I have enclosed a cheque/money order to the value of
$
☐ Please charge my credit card for the amount of
$
Card Type
☐ Bankcard
☐ MasterCard
☐ Visa Card
Expiry Date:
Card Number
Name on Card
Office
Use
Signature
Receipt Number:
Date:
Privacy statement
__________________
__________________
Personal information collected by Council is held securely
and used solely for municipal purposes as specified in the
Local Government Act 1989. Council may disclose this
information to other organisations if required or permitted
by legislation. Should you wish to access or modify this
information, please contact Council on (03) 5494 1200 or
email loddon@loddon.vic.gov.au
Loddon Shire Council
41 High Street, Wedderburn, Victoria
P.O. Box 21, Wedderburn, Vic 3518
Telephone: (03) 5494 1200
Facsimile: (03) 5494 3003
Email: loddon@loddon.vic.gov.au
Web: www.loddon.vic.gov.au
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New Dog and Cat registration form
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