PERFORMING ANIMALS LICENCE APPLICATION FORM
The Licensing Team Environment and Regulatory Services
Derby City Council The Council House Corporation Street Derby DE1 2FS
Application for a Performing Animals Licence
Part 1 – Applicant(s) Details
1.
First / Sole Applicant
Title: Mr Mrs Miss Ms Dr Other (please specify)
2.
Surname:
3.
Other name(s):
4.
Home Address:
5.
Telephone:
Postcode:
Daytime:
Mobile:
Evening:
6.
Email Address:
7.
Joint / Second Applicant (if applicable)
8.
9.
Title: Mr Mrs Miss Ms Dr Other (please specify)
Surname:
10.
Other name(s):
11.
Home Address:
12.
Telephone:
Postcode:
Daytime:
Mobile:
Evening:
13.
Email Address:
14.
Stage or Act Name:
15.
Have any of the applicants being registered under the Performing Animals
(Regulation) Act 1925? If so, please state which authority, the date and number of
the Certificate of Registration and the stage / act name used.
Part 2 – Premises Details
1. Full address where the
performance will take
place
Postcode:
2. Number of rooms being
used, including training
and housing
3. Arrangements for:
Heating
Ventilation
Lighting
Water
Disposal of soiled bedding
Food storage
4. Full list of the types of
animals being trained or
exhibited:
5. Describe the general
nature of the
performance(s) or
exhibitions the animals
will be taking part in.
Mention any equipment
used as part of the
performance, the
duration of the
performance and
number of performances
proposed.
Part 3 – Checklist and Declaration
I/We confirm that, to the best of my / our knowledge and belief, the information contained
in this application is true
I have submitted the appropriate fee.
I agree to pay the cost of any veterinary officer’s inspection of my animals, if deemed
necessary and understand that this will be charged at an hourly rate and that I will be
advised of the total amount once the inspection is completed. This fee must be paid
before the grant of any licence.
1. Signature of applicant or applicant’s solicitor or other authorised agent. If signing
on behalf of the applicant, please state in what capacity.
Signature
Print Name
Capacity
Date
2. For joint applications, signature of 2nd applicant, or 2nd applicant’s solicitor or
authorised agent. If signing on behalf of the applicant, please state in what
capacity
Signature
Print Name
Capacity
Date
If there are more than two applicants please enclose an additional sheet clearly marked
‘Signature(s) of further applicant(s)’