STAR - Microchip Registration Form

Registration number 1168941 - whose office address is at UK Kennels, Nuneaton Road, Mancetter, Warwickshire, CV9 1RF

Microchip number * is required.
Passport number * is required.
Implant date * is required.
Original name * is required.
New name * is required.
One option is required.
Breed * is required.
One option is required.
Date of birth * is required.
Colour * is required.
Neutered * is required.
First name is required.
Last name is required.
Address 1 * is required.
City is required.
County is required.
Post code is required.
Country is required.
Phone number * is required.
Alternative phone number is required.
Email address is required.
Terms and conditions
I hereby apply to become the registered keeper of this pet and confirm that I am 16 years old or over. I confirm that this pet is currently living with me at the address given above. I confirm that the information I have given is accurate. I also understand that current legislation regarding dogs requires me to keep these details up to date at all times. PETtrac and STAR reserves the right to contact you as a reminder of this.

I understand that this information will be retained by PETrac and STAR in order to fulfil the service offered by the database, and disclosed to any person who has requested and received authorisation, who is involved in securing the welfare of this pet. It may also be used for the enforcement of the Microchipping Regulations, and for the prevention or detection of crime relating to the welfare of dogs.

Please Send a £20.00 Microchip registration payment to STAR as follows:

Paypal : donations@staradopt.org

Bank: Metro Bank Sort Code: 23-05-80 Account number: 17429043

One option is required.

Help us save lives and support the rescue, rehabilitation and rehoming of dogs in need.