CARROLL COUNTY 4-H DOG CARE AND TRAINING PROJECT REGISTRATION FORM
NAME_________________________________________4-H AGE AS OF JANUARY 1ST_____________________
ADDRESS_______________________________________TOWN______________________________________
STATE_______________ZIP___________HOME PHONE #_______________ CELL PHONE # ________________
BIRTH DATE____________________________E-MAIL ADDRESS______________________________________
YOUR 4-H CLUB’S NAME______________________________________________________________________
YOUR DOG’S NAME __________________________________________SEX__________AGE_______________
SECOND DOG’S NAME_________________________________________SEX__________AGE______________
THIRD DOG’S NAME __________________________________________ SEX__________AGE______________
OWNER OF DOG_______________________________________LICENSE TAG NUMBER___________________
OWNER OF DOG_______________________________________LICENSE TAG NUMBER___________________
OWNER OF DOG_______________________________________LICENSE TAG NUMBER___________________
Please indicate date of inoculations and expiration date. (They must be up to date at Fair Time, as well as
when you begin training classes.)
RABIES:
Date Inoculated___________________Expiration Date_____________Rabies Tag Number________________
Date Inoculated___________________Expiration Date_____________Rabies Tag Number________________
Date Inoculated___________________Expiration Date_____________Rabies Tag Number________________
1. Number of years you have previously participated in this project______________________________
2. If you trained a dog other than the one listed on this form in previous years, please note the name of
the dog and the breed_________________________________________________________________
3. If you are training a dog this year that has also been trained by someone else, please list the type of
training it has received and who trained it_________________________________________________
4. List any titles your dog has in Obedience or Conformation____________________________________
REGISTRATION FEE
Dog Club Members ($5.00) All Other CC 4-H Members ($20.00)
PAID: YES (
)
NO ( )
University of Maryland Extension programs are open to all citizens and will not discriminate against anyone because of race, age, sex, color,
sexual orientation, physical or mental disability, religion, ancestry, or national origin, marital status, genetic information, or political affiliation, or
gender identity and expression.