Cat Registration Form » City of Kalgoorlie-Boulder

Owners Full Name*

Owners Postal Address including Suburb and Postcode*

Owners Phone Number*

Owners Email Address*

Concessions Holders (Pensioner Concession Holders, State Concession Card, Commonwealth Seniors Health Card with a WA Seniors Card)

YesNo

Please attach a photocopy

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Cat Name*

Cat Breed*

Cat Date of Birth*

Cat Colour*

Cat Gender*

MaleFemale

Is the Cat Sterilised?
Proof of sterilisation is required in the form of either
- Veterinary Surgeon's Certificate (please attach photocopy)
- Exemption for sterilisation or microchip from Vet
- Ranger sighting ear tattoo
- Approved Cat Breeder*

YesNo

Please upload Veterinary Surgeon's Certificate

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Contact Information for Responsible Vet Clinic

Approved Cat Breeder Contact Information

Microchip Number
All cats aged six months and over must be registered, sterilised and micro chipped (Cat Act 2011)

Address where cat is usually kept, include Suburb and Postcode*

Number of cats kept on property*

Emergency Contact Full Name*

Emergency Contact Phone Number*

By ticking this box, you certify that you have not had any convictions under the Cat Act 2011, Dog Act 1976, or Animal Welfare Act 2002 in the last three years; and the owner is not under the age of 18; and the particulars shown in this application are true to the best of your knowledge and belief.*

Yes