City of Wanneroo

Instructions

For enquiries that are of an urgent-nature that require immediate assistance or that relate to animals, parking, ranger assistance or other community safety matters, please call us on (08) 9405 5000

To ensure a timely and professional response, please complete this form with as much detail as possible.

Your personal information collected in this form will help us to complete your request or to improve our services, in accordance with the City's Personal Information Privacy Policy.

Application for more than 2 dogs

Customer Title (Required)

First Name (Required)

Last Name (Required)

Residential Address (Required)

Postal Address (if different from above)

Date of Birth (must be older than 18yrs) (Required)

Daytime Contact Number (Required)

Mobile Number

Email Address (Required)

DETAILS OF CURRENT DOGS REGISTERED WITH US

DETAILS OF FIRST DOG

First dog's name (Required)

First dog's breed (Required)

First dog's colour (Required)

First dog's gender (Required)

Is the first dog sterlised? (Required)

DETAILS OF SECOND DOG

Second dog's name (Required)

Second dog's breed (Required)

Second dog's colour (Required)

Second dog's gender (Required)

Is the second dog sterlised? (Required)

DETAILS OF THIRD DOG

Third dog's name (Required)

Third dog's breed (Required)

Third dog's colour (Required)

Third dog's gender (Required)

Is the third dog sterlised? (Required)

DETAILS OF FOURTH DOG

Fourth dog's name

Fourth dog's breed

Fourth dog's colour

Fourth dog's gender

Is the fourth dog sterlised?

DETAILS OF FIFTH DOG

Fifth dog's name

Fifth dog's breed

Fifth dog's colour

Fifth dog's gender

Is the fifth dog sterlised?

DETAILS OF SIXTH DOG

Sixth dog's name

Sixth dog's breed

Sixth dog's colour

Sixth dog's gender

Is the sixth dog sterlised?

Reason for requesting to keep more than two dogs *

Please provide details

Please upload Veterinary Surgeon's certificate as applicable

Please click below to upload files relating to this submission.

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