Medway Council - Stray Dog Collection Form

Medway Council Stray dog collection form

• Stray dog reference

• Conducted on

  Date

• Prepared by

• Is this report for a lost or found dog

  Select Lost Found

  • Lost
  • Found

• Date and time dog lost or found

  Date

• Location where dog lost or found

• Breed

• Sex

  Select Male Female Unable to establish

  • Male
  • Female
  • Unable to establish

• Age

  Select Puppy -Less than 1 year 1 2 3 4 5 6 7 8 9 10 Older than 10 Adult

  • Puppy -Less than 1 year
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • Older than 10
  • Adult

• Size

  Select As breed Small Medium Large

  • As breed
  • Small
  • Medium
  • Large

• Ears

  Select Floppy Up Pricked Half pricked Down

  • Floppy
  • Up
  • Pricked
  • Half pricked
  • Down

• Collar

• Peculiarities

• Colour

• Chip number and details

• Loser details

• Finder details

• Photo of dog collected by Community Warden.

  Media

Dog claimed or returned to owner.

• Dog placed in kennels

  Date

• Any notes relevant to placing dog in kennels

• Dog returned to owner

  Date

• I agree to pay all Medway Council charges on receipt of invoice. I understand that if my dog strays on any subsequent occasion it will be taken straight to the kennels and that I will be liable for all costs.

  Sign

• Dog claimed by owner

  Date

• Signature and address of purchaser or claimant

  Sign

• Charges

• Receipt number

• Retained on certificate

  Select Yes No

  • Yes
  • No

Declaration.

• I declare that I have no ownership or other interest in the dog described above, which I have handed to Medway Council as a stray dog. I believe, to the best of my knowledge, that this information is true and I understand that making a false or misleading declaration may render me liable to legal action.

  Yes

  No

  N/A

• Print full name and date.

  Sign