Animal Boarding Establishments Act 1963
Application for a Licence to Keep a Home Boarding Establishment for Dogs
Please read the notes at the foot of this form before completing it.
APPLICANT
Full Name:
Date of Birth:
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Address:
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........................................................................ Postcode: .................................................
Telephone number:
Mobile number:
Email address:
BUSINESS DETAILS (IF APPLICABLE)
Business Name:
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Address (if different from above):
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........................................................................ Postcode: .................................................
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OFFENCES, DISQUALIFICATIONS ETC.
Have you (or any other person who may be involved in the control or management of the premises) ever been
(a)
Convicted of any offence involving animals?
YES
/
NO
(b)
Disqualified under animal related legislation?
YES
/
NO
(c)
Ever had a licence refused, revoked or cancelled?
YES
/
NO
If the answer to any of these questions is ‘yes’ then please supply full details on a separate sheet. Any information
supplied is subject to the Rehabilitation of Offenders Act 1974.
ANIMALS
How many dogs do you intend to board (max of 4 inclusive of household dogs)? ....................................................................
ANIMAL ACCOMMODATION AND HUSBANDRY
What type of accommodation will you be using for the dogs: ...................................................................................................
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What steps will you take to ensure that the animals will, at all times, be kept in accommodation suitable in respect of:
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(a) Construction
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(b) Size of quarters
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(c) Number of occupants
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(d) Exercise facilities
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(e) Temperature
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(f)
Lighting (natural & artificial)
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(g) Ventilation
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(h) Cleanliness
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Describe the steps that will be taken to ensure that the animals will be adequately supplied with:
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(a) Food
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(b) Drink
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(c) Clean bedding material
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Describe the steps that will be taken to ensure that the animals will be:
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(d) Adequately exercised
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WASTE
How do you propose to dispose of waste material* from the establishment: ..........................................................................
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* Waste material – anything that is no longer required is waste, this may include old mail, advertising materials you have
been sent and do not want, used cleaning products, remains of food eaten on your premises, cardboard, sweepings,
packaging including boxes and bags as well as animal faeces.
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FIRE PRECAUTIONS
What steps do you intend to take for securing that the animals will be protected in case of fire (please list any equipment
provided): ...................................................................................................................................................................................
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DISEASE CONTROL
What steps do you intend to take for preventing and controlling the spread of infectious or contagious diseases? ...............
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What isolation facilities will be provided? ..................................................................................................................................
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REGISTER OF ANIMALS
What arrangements will be made for keeping a register/record of animals kept at the premises? .........................................
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VETERINARY TREATMENT
Please give details of your Veterinary Surgeon or practitioner.
Name:
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Address:
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........................................................................... Postcode: ...................................................
Telephone Number:
PUBLIC LIABILITY / INSURANCE
Details of Public Liability, Employers Liability and Animal Stock insurance cover:
Name of Company:
................................................................................................................................................
................................................................................................................................................
Address of Company:
................................................................................................................................................
........................................................................... Postcode: ...................................................
Telephone Number:
NB: Please enclose a copy of Certificates of Insurance.
PAYMENT OF LICENCE FEE
The fee for a home boarding licence is listed on our website and this is renewable annually. Cheques need to be made
payable to Waverley Borough Council or alternatively you can pay over the phone using a debit or credit card by calling
01483 523393 (this should be done once your application has been made to the Council).
I wish to pay by:
 Cheque
 Card payment
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DECLARATION
I have not been disqualified from holding a licence under any of the Animal Welfare Acts, namely Animal Boarding
Establishments Act 1963, Breeding of Dogs Act 1973, Pet Animals Act 1951, Riding Establishments Acts 1964 and 1970,
and the Dangerous Wild Animals Act 1976.
I understand that a licence can only be granted if the Council is fully satisfied with the answers I have given in completing
this application.
I confirm that I have answered the questions truthfully and correctly to the best of my knowledge and belief. I agree to
the Council’s Officers making any enquiries necessary to verify the information given by me including reference to
relevant records and registers, nominated referees and any relevant recognised bodies or organisations.
I make this application and I have answered the above questions knowing that if the licence is granted, I shall be liable to
prosecution if I have wilfully stated in any answer anything which I know to be false or do not believe to be true.
I declare that the answers to the above questions to be correct in every respect.
NAME:
SIGNATURE:
DATE:
NOTES
1.
2.
3.
Please complete this form in block capital letters and return it to: Environmental Health, Waverley Borough Council,
The Burys, Godalming, Surrey, GU7 1HR.
Failure to submit an application for renewal before a current licence expires will result in a lapse of the licence and
all licensable activity must cease until an application has been processed and a new licence issued.
The Council’s Environmental Health Officers will deal with the technical aspects of this application. The appropriate
officer can be contacted on 01483 523393.
The applicant should bear in mind that:
(a)
(b)
The proposed licence conditions will only be determined at the end of the application process.
If no licence is currently in force the activity for which the licence is being applied for cannot be started / carried on.
You should seek independent legal advice if you have any queries about this issue.
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(c)
It is recommended that you read the supplied conditions and ensure you are compliant with them before making an
application. Licences will only be granted with the supplied conditions attached.
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