Ministry of Agriculture, Food and Rural Affairs

Application for Registration of Research Facility under the Animals for Research Act

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New Application

The following information is required to register a research facility or facilities under the Animals for Research Act. Please complete the following form:

Name of Organization: ___________________________________________________

Name of the Operator: ___________________________________________________

Position Title: __________________________________________________________

Telephone: _______________________

Fax: _____________________________

Email: _________________________________________________________________

Mailing Address: _________________________________________________________

City/Town: ______________________________________________________________

Postal Code: ______________________

Contact Name (if different): ________________________________________________

Position Title: ____________________________________________________________

Telephone: _______________________

Fax: _____________________________

Email: _________________________________________________________________

List of Animal Facilities

Name of Animal Facility: ___________________________________________________

Address: ________________________________________________________________

City/Town: ______________________________________________________________

Postal Code: ______________________

Building Name(s) (if applicable): ____________________________________________

On-Site Contact Name: ____________________________________________________

Position Title: ____________________________________________________________

Telephone: _______________________

Fax: _____________________________

Email: __________________________________________________________________

____ A list of additional facilities are provided on a separate sheet(s) and included with this application.

Animal Care Committee

Attach a list of the current members of the Animal Care Committee (ACC) and identify each member's role on the committee. (eg. Dr. X, Veterinarian; Dr. Y, Scientist; Mr. Z, Community Representative).

Are you acquiring new animal facilities, planning renovations or new construction of animal facilities in 2017?

____ Yes. If yes, please notify the Ministry via the Chief Veterinary Inspector of the premises proposed to be used, constructed or reconstructed and forward plans and specifications for approval prior to starting the project.

____ No

I, the undersigned, certify that the foregoing information is, to the best of my knowledge, true, and correct. I undertake to furnish to the Director, Animal Health and Welfare Branch, details of any changes from the information stated on this form no later than 10 business days after the date changes are made.

Dated this ______ day of _____________, 20___

Print Name: ____________________________________________________________

Signature: _____________________________________________________________

Position Title: ___________________________________________________________

Language Preference:

____ English

____ French

List of Additional Animal Facilities

Please complete the below to register additional facilities under the Animals for Research Act.

Name of Animal Facility: _________________________________________________

Address: ________________________________________________________________

City/Town: ______________________________________________________________

Postal Code: ______________________

On-Site Contact Name: ____________________________________________________

Position Title: ____________________________________________________________

Telephone: _______________________

Fax: _____________________________

Email: __________________________________________________________________

Name of Animal Facility: ___________________________________________________

Address: ________________________________________________________________

City/Town: ______________________________________________________________

Postal Code: ______________________

On-Site Contact Name: ____________________________________________________

Position Title: ____________________________________________________________

Telephone: _______________________

Fax: _____________________________

Email: __________________________________________________________________

Please complete, sign and return this form together with the appropriate fee(s), $200.00 for the first facility and $100.00 for each additional facility, and your current ACC membership list.

Please make cheques payable to the Minister of Finance. A cheque not honoured by your bank will be subject to a $35.00 service charge.

Mail completed applications to:

Animals for Research Registration
Animal Health and Welfare Branch
Ministry of Agriculture and Food and
Ministry of Rural Affairs
1 Stone Road West, 5th Floor NW
Guelph, ON N1G 4Y2

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