Community Connections Day Microchip Booking
I am attending a Community Connections Day and wish to bring my dog for microchipping.
This offer is not available to breeders and people whose dogs are not good around other dogs. 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.
Which location is the Community Connection Day you are attending?
*
Port Adelaide Uniting Church 8th October
"Fremont Park" Elizabeth 15th October
"Pine Park" Murray Bridge 13th November
Dog Owner's Name:
*
First Name
Last Name
Dog 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.
Alternate / Secondary Contact Name:
Alternate Contact Phone Number:
Please enter a valid phone number.
The following questions are required, to enter the microchip details onto the Dog and Cat Management Board Database.
Dog's name:
*
Date of Birth or Approximate Age:
*
Primary Breed:
*
Secondary Breed:
Primary Colour:
*
Secondary Colour:
Distinguishing Features:
Is this dog registered:
*
Yes
No
Unknown
If registered, in which council?
Is this dog 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
Browse Files
Drag and drop files here
Choose a file
Cancel
of
THERE ARE LIMITED BOOKINGS AVAILABLE. YOU WILL BE CONTACTED AND ALLOCATED A TIME BETWEEN 1130 -230. 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:
Submit
Should be Empty: