Surname:
Full Address including Postcode:
Telephone Numbers
Including Area Code
Initials:
Home:
Mobile:
Mr/Mrs/Ms/Miss
Work:
Emergency:
E-Mail address:
Name of Pet: Date of birth/approx age:
Species (please circle) Dog Cat Other, please state:
Breed:
(eg: Border Collie/ Xbreed/mixed breed/domestic shorthair)
Sex (please circle) Male Female
Neutered YES / NO
Colour:
Microchip Number (15 digits)
Vet name & Address (UK)
(must be completed)
Implant date:
Passport No:
To assist in processing your request successfully, please attach copies of any documentation including: bill of sale, vaccination records, rehoming forms etc. If you are unable to supply these then please provide brief details on how you obtained the pet below:

I hereby apply to register keeper details of the above named pet. I understand that the certificate issued to me is on the basis that should there be a subsequent objection, Petlog reserves the right to review the situation and cancel the change, and where applicable any associated registrations if deemed necessary.

I understand that the information I have given on this form will be retained by Petlog and hereby agree that it may be disclosed to any person or persons involved in securing the welfare of the pet above.
Signature Date
1. Please charge £16 to my credit/debit card
(delete where applicable)
Visa Mastercard Delta Switch/Maestro Electron
Card Number
Expiry date / Issue No CCV No
2. Cheques made payable to Petlog for £16.00 enclosed
Signature Date
Your name, contact details and email address will be retained by the Kennel Club* From time to time, the Kennel Club may con tact you by mail, email, telephone to tell you about our related services available. By providing us with your address, telephone number or email address and registering with us you consent to being contacted by these methods for these purposes.
If you do not wish to receive details of services from the Kennel Club*, please tick this box.
* Petlog is managed by the Kennel Club
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