Online Form - Working Dog Registration Form

Owner's Full Name*

Residential Address*

Postal Address (if different)

Contact Number*

Dog's Name*

Breed*

Shire Registration Number*

I declare that the above-mentioned dog meets the essential criteria of being trained and used primarily for the droving or tending of stock.

I understand failure to satisfy that my dog meets at least three of the following criteria may result in my application being refused.

The property that the dog works on is larger than 2 hectares*

YesNo

I am a primary producer with a PIC and ABN*

YesNo

There are more than 8 head of stock on the property that the dog works on.*

YesNo

My dog is a recognised working dog breed.*

YesNo

Is there any other relevant information you have to support your application?*

Section 20 (1) (b) of the Dog Act 1976 state that it is an offence, for the purpose of obtaining any benefit or avoiding any penalty, to wilfully make or cause to be made any representation or statement which is false or misleading in any material form. The penalty for an offence relating to a dog other than a dangerous dog is a fine of $5000. Are you willing to submit this application, and by doing so declare that all information provided is true and correct?*

YesNo