Online Form - Online Dog Registration

This form is for residents and households in the Port Hedland Local Government Area who need to register their dogs. YOU CAN ONLY REGISTER ONE DOG PER FORM SUBMISSION.

Please note registration will not be valid until supporting evidence has been reviewed and payment received which can take up to 2 business days. A customer service officer will contact you regarding payment during business hours.

Owner Details

Dog owners full name *

Date of birth *

Residential Address *

Postal address if different

Contact number (mobile preferred) *

Email *

Pension Concession Number if applicable*

Attach copy of photo id (mandatory) *

Attach copy of pensioner concession card if field is completed

Dog Details

YOU CANNOT REGISTER ONLINE IF:
- You are trying to register more than one dog at once
- The dog has been declared dangerous or is a restricted breed
- The dog cannot be effectively confined in or at the premises listed above
- The dog is a pit bull terrier, an American Pit Bull Terrier or a mix of one or both of these
breeds

Previous Convictions, Relevant Orders

If you answer yes to the below questions you are unable to register online. Call 9158 9300 during office hours to make an appointment with rangers.

Do you have any convictions for offences against the Dog Act 2011 or Animal Welfare Act 2002 in the past 3 years? *

YesNo

Are you currently banned from owning or keeping a dog under an order under the dog Act 1976 46A (2) either permanently or for a period specified in the order? *

YesNo

Declaration

I DECLARE THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT. I AM AWARE THAT IT IS AN OFFENCE TO PROVIDE FALSE AND MISLEADING INFORMATION.

The local government may refuse an application if any or all of the required information is not provided.

Your Name *

Your Address *

Your Signature *

Date *