DUE MAY 15, 2012 BY 4:30 PM
AT EXTENSION OFFICE
IOWA 4-H DOG IDENTIFICATION REPORT
Name of Exhibitor: _______________________________ Grade (’11-’12) _____
Address: ______________________________ City ________________________
Name of Club: ______________________________________________________
I hereby certify that the following are owned, being fed, and cared for by me as part of my
4-H/FFA dog project. I have read the regulations as specified in the Fairbook.
I verify my child’s statement.
_______________________________________
Signature of 4-H/FFA Member
Dog’s
Name
* Include this year.
Rabies
Vaccination
Number
Date of
Rabies
Vaccination
____________________________________
Signature of Parent/Guardian
*Years of Training
Member
Dog
Breed
Sex
Birth Date
mo/day/yr