Animal Boarding Establishments Act 1963

ANIMAL BOARDING ESTABLISHMENTS ACT 1963 APPLICATION FOR LICENCE TO KEEP A HOME BOARDING ESTABLISHMENT FOR DOGS/CATS

To: Gateshead Council

Name: Miss / Ms / Mrs / Mr / Other: Address:

Name of Company: Postcode: Date of Birth: Telephone Numbers: Email: as (proposed) occupier(s) of the premises hereinafter mentioned HEREBY MAKE APPLICATION in pursuance of Section 1 of the Animal Boarding Establishments Act 1963 for a LICENCE TO KEEP AN ANIMAL BOARDING ESTABLISHMENT at the premises of which particulars are given below.

Please enclose payment with the application form. The application will not be processed until the appropriate fee has been paid. 1 (a) Are you disqualified under the act from keeping a boarding establishment for animals? or (b) under the Pet Animals Act 1951 from keeping a pet shop; or (c) under the Protection of Animals (Cruelty to Dogs) Act 1933, from keeping a dog; or (d) under the Protection of Animals (Cruelty to Dogs) (Scotland) Act 1934, from keeping a dog; or (e) under the Protection of Animals (Amendment) Act 1954 from having custody of Animals; or (f) any offence under any of sections 4, 5, 6(1) And (2), 7 to 9 and 11 of the Animal Welfare Act 2006 2 Number of dogs/cats to be boarded on the premises:

3 Exercise and garden facilities including fencing:

4 Heating arrangements:

5 Method of ventilation of premises: 6 Lighting arrangements:

7 Water supply:

8 Arrangement for food storage:

9 Arrangements for disposal of excreta:

10 Description of isolation facilities for the control of infectious disease:

11 What provision has been made to deal with fire or other emergencies?

12 Has the Fire Officer been consulted regarding fire precautions?

13 Is an adequate register kept of all animals?

14 Name and address of Veterinary Practitioner:

Please ensure that the information requested in the above boxes is completed as comprehensively as possible, as incomplete application forms may have to be returned.

I/WE DO HEREBY CERTIFY that to the best of my/our knowledge and belief, the above particulars are true.

(Signed) ………………………………………………

*……………………………………………………… Date: ………………………......

NOTE * Capacity, if Applicant signs on behalf of a Company or Partnership