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The Animal Welfare (Licensing of Activities Involving Animals) Regulations 2018
Application to register for the exhibition or training of performing
animals
Please complete all the questions in the form.
If you have nothing to record, please put "n/a" or "none"
Applicant Profile Section
1 Reference number
1.1
System reference number
1.2
Your reference
1.2a
Agent
1.2.1
Are you an agent acting on behalf of
the applicant?
Yes No If no go to 1.3
1.2b
Further information about the agent
1.2.2
Name
1.2.3
Address
1.2.4
Email
1.2.5
Main telephone number
1.2.6
Other telephone number
1.3
Applicant details
1.3.1
Name
1.3.2
Address
1.3.3
Email
1.3.4
Main telephone number
1.3.5
Other telephone number
1.3.6
Applying as a business or
organisation, including a sole trader
Yes
No
1.3.7
Applying as an individual
Yes No
1.4a
Applicant business
1.4.1
Is your company registered with
companies house?
Yes No If no go to1. 4.3
1.4.2
Registration number
1.4.3
Is your business registered outside the
UK?
1.4.4 VAT number
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1.4a
Applicant business
1.4.5 Legal status of the business
1.4.6 Your position in the business
1.4.7
The country where your head office is
located
1.4.7b Business address – this should be your official address – the address required of you by law to
receive all communication
1.4.8
Building name or number
1.4.9
Street
1.4.10
District
1.4.11
City or town
1.4.12
County or administrative area
1.4.13
Post code
1.4.14
Country
Type of Business Section
2
Type of business/performance (please tick)
2.1
TV/film/social media
2.2
Theatre
2.3
Circus using domestic animals
2.4
Exhibiting animals
2.5
Animal encounters
2.6
Birds of prey shows/exhibits
2.7
Other please state
3a
Application details
3.1
Have you been registered/licenced
before?
Yes If no go to 3.3
3.2
Local Authority where
registered/licenced
3.3
Give details of registration e.g. type and
numbers of animals, type of
performance or exhibition
3b
Further information about the applicant
3.4
Stage name (if any)
3.5
Nationality
3.6
Date of birth
4
Animals to be trained
4.1 Name of premises/trading name
4.2 Address of premises
4.3 Telephone number of premises
4.4 Email address
No
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5a
Kinds of animal to be trained and the number of each kind 1
5.1
Kind of animal
5.2 Number
5.3
Add another kind of animal?
Yes
No
If no, go to 6.1
5b
Kinds of animal to be trained and the number of each kind 2
5.4
Kind of animal
5.5 Number
5.6
Add another kind of animal?
Yes
No
If no, go to 6.1
5c
Kinds of animal to be trained and the number of each kind 3
5.7
Kind of animal
5.8 Number
5.9
Add another kind of animal?
Yes
No
If no, go to 6.1
5d
Kinds of animal to be trained and the number of each kind 4
5.10
Kind of animal
5.11 Number
5.12
Add another kind of animal?
Yes
If no, go to 6.1
6a Kinds of animal to be exhibited/encounter and the number of each kind 1
6.1
Kind of animal
6.2 Number
6.3
Add another kind of animal?
Yes
No
If no, go to 7.1
6b
Kinds of animal to be exhibited/encounter and the number of each kind 2
6.4
Kind of animal
6.5 Number
6.6
Add another kind of animal?
Yes
If no, go to 7.1
6c
Kinds of animal to be exhibited/encounter and the number of each kind 3
6.7
Kind of animal
6.8 Number
6.9
Add another kind of animal?
Yes
If no, go to 7.1
6d
Kinds of animal to be exhibited/encounter and the number of each kind 4
6.10
Kind of animal
6.11 Number
6.12
Add another kind of animal?
Yes
If no, go to 7.1
7 Proposed performance or encounter
7.1 Describe the nature of the performance
(s) in which the ani
mals will be exhibited
or for which they are to be trained,
mentioning any apparatus which is used
for the purpose of the performance. The
description must be sufficient to give a
general idea of what is done by the
animals taking part in the performance.
If it is an animal encounter please give
details of what type of encounter and
where these are to take place.
No
No
No
No
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7
Proposed performance or encounter
7.2
Approximate duration of the performance
(s)
7.3
Number of times the performance will be
given in one day
7.4 How will the animals be transported?
7.5
Where are the animals to be kept when
not performing or being exhibited?
8
Veterinary surgeon
8.1 Name of usual veterinary surgeon
8.2 Company name
8.3 Address
8.4 Telephone number
8.5
Email address
9a
Emergency key holder 1
9.1 Do you have an emergency key holder? Yes No If no, go to 10.1
9.2
Name
9.3
Position/job title
9.4
Address
9.5 Daytime telephone number
9.6 Evening/other telephone number
9.7 Email address
9.8 Add another person? Yes No If no, go to 10.1
9b
Emergency key holder 2
9.9
Name
9.10
Position/job title
9.11
Address
9.12 Daytime telephone number
9.13 Evening/other telephone number
9.14 Email address
10
Public liability insurance
10.1 Do you have public liability insurance? Yes No If no, go to question 10.6
If yes, please provide details of the policy
10.2 Insurance company
10.3 Policy number
10.4 Period of cover
10.5 Amount of cover (£m)
10.6
Please state what steps you are taking
to obtain such insurance
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11
Disqualifications and convictions
Has the applicant, or any person who will have control or management of the establishment, ever been
disqualified from:
11.1
Keeping a pet shop?
Yes
No
11.2
Keeping a dog?
Yes
No
11.3
Keeping an animal boarding establishment?
Yes
No
11.4
Keeping a riding establishment?
Yes
No
11.5
Having custody of animals?
Yes
No
11.6
Has the applicant, or any person who will have control or
management of the establishment, been convicted of any
offences under the Animal Welfare Act 2006?
Yes
No
11.7
Has the applicant, or any person who will have control or
management of the establishment, ever had a licence
refused, revoked or cancelled?
Yes
No
11.8
If yes to any of these questions, please provide details
12
Additional details
Please check local guidance notes and conditions for any additional information which may be required
12.1
Additional information which is required or may be
relevant to the application
Payment and Declaration Section
13 Payment
13.1
Payment must be made at the time of making the application
13.2
Please see website page for the relevant fees
14
Model licence conditions and guidance
All applicants to tick that they have read the applicable model licence conditions and guidance
14.1
Selling pets
14.2
Animal boarding
14.3
Performing animals
14.4
Riding establishments
14.5
Dog breeding
15
Additional information
Please attach the following information
15.1
A plan of the premises
15.2
Insurance policy
15.3
Operating procedures
15.4
Risk assessments (including fire)
15.5
Infection control procedure
15.6
Qualifications
15.7
Training records
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16
Declaration
16.1
This section must be completed by the applicant. If you are an agent please ensure this section is completed
by the applicant.
16.2
I am aware of the provisions of the relevant Act and model licence conditions. The details contained in the
application form and any attached documentation are correct to the best of my knowledge and belief.
16.3
Ticking this box indicates you have read
and understood the above declaration
16.4
Full name
16.5
Capacity
16.6
Date
Please return this application form to:
Environmental Health Services
Harlow Council
Civic Centre
The Water Gardens
Harlow
Essex CM20 1WG
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