Rangers - Dog Attack Statement - Dog Owner or Person in Control

Introduction

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Personal information

Personal information

Gender*This field is required.
Contact details

Contact details

Description of your dog/s

Gender of the dog*This field is required.
is/are the dog registered*This field is required.
Is/are the dogs/s microchipped?*This field is required.
Are you aware of an incident regarding an alleged dog attack?*This field is required.
Was anyone else looking after your dog/s at the time of the incident?*This field is required.
Were there any injuries?*This field is required.

Details of the incident - Part A

Were there any witnesses to the incident? If Yes, provide names and contact details on the next page*This field is required.

Witness details

Details of the incident - Part B

Details of the incident - Part C

Has the dog/s ever shown any aggressive behaviour in the past?*This field is required.
Has the dog/s ever been declared dangerous, within the Town or within another jurisdiction?*This field is required.
Have you ever received infringements or been convicted for breaches of the Dog Act 1976 (WA)?
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Declaration

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Have you been threatened by any person to make this statement?*This field is required.
Do you agree this is a true statement?*This field is required.
Do you understand that by making this statement that if it is tendered in evidence I will be guilty of a crime if I have willfully included in this statement anything, which I know to be false, or that I do not believe to be true?*This field is required.

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