Application for Dog Registration Form - Racing Greyhound

Please use this form to apply for registration of your greyhound for racing purposes under Domestic Animals Act 2000, 39C (1).

A dog must be registered if it is over eight weeks old. From 14 December 2017, dogs in the ACT are no longer required to wear a yellow registration tag. However, owners are encouraged to always have an identification tag on their pet: In particular, to have the name of the pet and a contact number included, so the pet can be quickly reunited with its family if it becomes lost.

Registration of a Greyhound for racing purposes is valid for 12 months

APPLICANT DETAILS:

Is the dog owned by a syndicate or are there other parties involved in the ownership of this dog? (Please Circle): Yes No

If the dog is owned by a syndicate or more than one person owns the dog please submit a separate form providing details for each owner/syndicate member.

APPLICANT No:

Your Details

Name:
Address:
Phone number:
Mobile (if different):
Email:

Have you had any conviction or finding of guilt within the last 10 years against a law of a Territory or State for an offence relating to greyhound racing or the welfare, keeping or control of an animal?

☐ Yes ☐ No

Have you had any disciplinary action taken against you under a gaming law or a rule of racing or betting, in the ACT or elsewhere?

☐ Yes ☐ No

Have you received assistance from the Territory in relation to the end of greyhound racing in the ACT?

☐ Yes ☐ No

DOG DETAILS:

Please provide details of the racing greyhound for which you are applying to register:

Dogs Name: ______

Age of Greyhound: ______years, ______months.

Sex of dog, (please circle): MaleFemale

Male (desexed)Female (Desexed)

Microchip Number: ______

Greyhound racing controlling body the greyhound is registered with (if applicable):

______

Address where dog is kept

______

By signing this form I acknowledge that the above information is true and correct to the best of my knowledge. I understand that it is an offence under the Criminal Code 2002 to make false and misleading statements.

I declare that I am an owner of this greyhound which will be used for racing purposes:

Signature:______Date:

Please note: When your application has been submitted, an assessment will be made by Domestic Animal Services Staff and you will be contacted to finalise your application and make payment of the appropriate fees

If you have any questions regarding this application process please contact Access Canberra on 13 22 81

This application can be submitted via:

Email:

Postal:Domestic Animal Services

GPO BOX 158

Canberra City ACT 2601

Or delivered in person between 10am and 3pm on Monday, Tuesday, Thursday, Friday and Saturday to: Domestic Animal Services, Mugga Lane, Symonston ACT

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