2023 Dog Registration Form
Please complete 1 form for each dog that you intend to show
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電子郵件 *
Special Considerations
4-H Member Information
Member's First Name *
Member's Last Name *
4-H Age (Age as of Jan 1st, 2023) *
Date of Birth *
MM
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DD
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YYYY
Street Address *
City *
Zip Code *
Parent(s)/Guardian(s) *
Parent(s) Phone *
Parent(s) Email *
4-H Club *
4-H Dog Information
Dog's Name *
Dog's Sex *
Dog's Breed *
Neutered/Spayed *
Vaccination Information
IMMUNIZATIONS: A copy of each dog's immunization record is required
REQUIRED: Distemper/Parvovirus/Adenovirus (Hepatitis), Rabies, & Leptospirosis
RECOMMENDED: Bordetella
Distemper/Parvovirus/Adenovirus (Hepatitis) Expiration Date *
MM
/
DD
/
YYYY
Rabies Expiration Date *
MM
/
DD
/
YYYY
Leptospirosis Expiration Date *
MM
/
DD
/
YYYY
Bordetella Expiration Date
MM
/
DD
/
YYYY
Dog Registrations are due: June 5th, 2023
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