2015/16 Response Services
Dog Registration Application
Animal Management (Cats and Dogs) Act 2008
1. Applicant details
Please note that the registered owner/s of the animal/s must be 18 years of age or older
Title
Surname
Given names
Date of birth
Postal address
Suburb
State
Business phone
Postcode
A/H phone
Mobile
Email address
Fax
Pension Card No.: (if a pensioner)
2. Property address details (where animal will be kept)
Property Address
Property no.
Suburb
State
Postcode
Transferred from another Council? Please name Council and current registration number:
3. Animal details 1
Dog name
Breed
Colour
Age
Sex

Male

Female
Desexed

Yes, complete vet details

No
Vet name __________________________________________________________________________________
Phone number ______________________________________________________________________________
Address ___________________________________________________________________________________
Any other noticeable, distinguishing features or marks:
Microchip number:
Microchip supplier:
4. Animal details 2
Dog name
Breed
Colour
Age
Sex

Male

Female
Desexed

Yes, complete vet details

No
Vet name __________________________________________________________________________________
Phone number ______________________________________________________________________________
Address ___________________________________________________________________________________
Any other noticeable, distinguishing features or marks:
Microchip number:
Microchip supplier:
If the number of animals you wish to register exceeds the permissible number allowed on your property, you will need to
apply for a licence.
Privacy
Council will use any personal information provided for the intended purpose only and for remaining in contact with you. Council is
authorised to collect this information in accordance with the Local Government Act 2009 and other Local Government Acts. Your
personal information is only accessed by persons authorised to do so. Your personal information is dealt with in accordance with
council’s privacy policy.
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2015/16 Response Services Dog Registration Application V2 03/08/15
5. Animal annual registration fees & charges
Animal registration period is 1 October 2015 to 30 September 2016
Regulated Dog - (Declared dangerous, restricted or menacing)
$409.00
Is animal declared dangerous?  Yes  No
Is animal declared menacing?
 Yes  No
Is animal declared restricted?
 Yes  No
Non desexed dog
$128.00
Non desexed dog - owned by a pensioner
$108.00
Racing Greyhound - owned by a member of a Greyhound racing club (proof required)
$68.00
Non desexed dog - owned by a member of the Canine Control Council or similar state or national
organisation (proof required)
$68.00
Desexed dog
$29.00
Desexed dog - owned by a pensioner
$21.00
Desexed dog with microchip (PID)
$13.00
Desexed and micro chipped (PID) dog - owned by a pensioner
$0.00
Guide, hearing and assistance dogs
$0.00
Puppy - up to 6 months of age
$0.00
Replacement Tag
$0.00
6. Declaration of applicant
I/We, the applicant, declare that the above information is correct in all respects, at the time of lodgement of this
application with the Sunshine Coast Regional Council. Should any of the details given in relation to this application be
changed in the future, the applicant shall advise the Sunshine Coast Regional Council in writing prior to any such change
being implemented.
Signature
Date
Signature
Date
OFFICE USE ONLY
Animal no. 1
Amount paid
Date paid
Receipt no.
Initial
Date stamp
Tag no.
Animal no. 2
Tag no.
Payment options
In person
Customer service centres: 8.30 am to 4.30 pm Monday to Friday (excludes public holidays).
By mail
Cheque or money order to be made payable to: Sunshine Coast Regional Council.
 Cheque
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 Money order
 Mastercard
 Visa
Card number
Expiry date
Amount $
Name on card
Signature of cardholder
Phone
Is a receipt required?
2015/16 Response Services Dog Registration Application V2 03/08/15
 Yes
 No