Community Connections Day Microchip Booking
I am attending a Community Connections Day and wish to bring my dog or cat for microchipping.
This offer is not available to breeders. There will be multiple dogs present at this event- By completing this form, you are acknowledging that you cannot bring an aggressive, non-socialised, anxious or reactive dog. If your dog is not suitable to attend, come have a chat to us on the day about being referred to one of our pop up vet clinics.
Which location is the Community Connection Day you are attending?
*
Pine Park - Murray Brige 23/07/2026
Prince George Plaza - Elizabeth 17/07/2026
Salvation Army- Morphett Vale 28/07/2026
Owner's Name:
*
First Name
Last Name
Owner's Email:
*
example@example.com
Owner's Date of Birth:
*
-
Day
-
Month
Year
Date
Owner's Phone Number:
*
Please enter a valid phone number.
Format: 0000 000 000.
Alternate / Secondary Contact Name:
Alternate Contact Phone Number:
Please enter a valid phone number.
Format: 0000 000-000.
The following questions are required, to enter the microchip details onto the Dog and Cat Management Board Database.
Animal name:
*
Date of Birth or Approximate Age:
*
Primary Breed:
*
Secondary Breed:
Primary Colour:
*
Secondary Colour:
Distinguishing Features:
Are they currently registered:
*
Yes
No
Unknown
If registered, in which council?
Is the animal desexed?
*
Yes
No
Unknown
Signature
Do you hold a Concession Card?
*
Yes
No
What is your concession card number?
*
Please upload a copy of your concession card if you have it
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THERE ARE LIMITED BOOKINGS AVAILABLE. YOU WILL BE CONTACTED AND ALLOCATED A TIME BETWEEN 11am -2pm. IF YOU ARE UNABLE TO ATTEND, PLEASE CANCEL YOUR BOOKING SO IT CAN BE OFFERED TO SOMEONE ELSE.
For Vet / Implanter Completion Only:
Microchip Number:
Comments:
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