Westchester County 4-H Animal Identification Certificate
3 West Main Street, Suite 112 Elmsford, NY 10523 Tel: 914-285-4620 / Fax: 914-285-4624 E-mail: [email protected] Web: http://westchester.cce.cornell.edu/
Westchester County 4-H Animal Identification Certificate and Project Animal Declaration Animal’s Owner Information Name: _________________________________________________________________ Address: _______________________________________________________________ Phone Number: _________________________________________________________ Signature: ______________________________________ Date: _______________ Name of youth participant _____________________________________________ Clubs utilizing the same animal for multiple members may list the Club’s Name as the Youth Participant here. Details for each youth are entered on next page. Animal’s Information Name/ID# of Animal: ___________________________________________________ Animal’s Birthdate (or approximate age): __________________ Species/Breed: __________________________________________________________ Identifications (tattoos, eartags, ear notches, etc): ____________________________ ________________________________________________________________________ For rabbits, dogs, poultry and small animals, please attach clear color photos of your animal. Computer printed photos are acceptable. For your convenience you may e-mail photos to [email protected] - label subject as “Fair Animal Photo”.
Building Strong and Vibrant New York Communities Cornell Cooperative Extension is an employer and educator recognized for valuing AA/EEO, Protected Veterans, and individuals with disabilities and provides equal program and employment opportunities. Please contact CCE of Westchester if you have any special needs
Youth’s Information Name: ________________________________
Age (on Jan 1st) _______________
Address: _______________________________________________________________ Phone Number: _______________________(cell)____________________________ Signature: ______________________________________ Date: _________________ By signing here you declare that the animal listed on this form will be cared for by the youth and is officially designated as his/her 4-H Project Animal as of March 19 of the current year. Parent/Guardian Information Name: _________________________________________________________________ Address: _______________________________________________________________ Phone Number: _______________________ (cell)_____________________________ Signature: ______________________________________ Date: _________________ 4-H Leader’s Signature ___________________________ Date: _________________ 4-H Educator’s Signature: _________________________ Date: _________________
This form must be completely filled out and on file with Cornell Cooperative Extension of Westchester County in order for youth to be eligible to exhibit animals at the Putnam County 4-H Fair, the Westchester 4-H Showcase, the New York State Fair 4-H youth animal classes, and if you are bringing your project animal to the Yorktown Grange Fair.
Westchester County 4-H Animal Identification Certificate and Project Animal Declaration Animal’s Owner Information Name: _________________________________________________________________ Address: _______________________________________________________________ Phone Number: _________________________________________________________ Signature: ______________________________________ Date: _______________ Name of youth participant _____________________________________________ Clubs utilizing the same animal for multiple members may list the Club’s Name as the Youth Participant here. Details for each youth are entered on next page. Animal’s Information Name/ID# of Animal: ___________________________________________________ Animal’s Birthdate (or approximate age): __________________ Species/Breed: __________________________________________________________ Identifications (tattoos, eartags, ear notches, etc): ____________________________ ________________________________________________________________________ For rabbits, dogs, poultry and small animals, please attach clear color photos of your animal. Computer printed photos are acceptable. For your convenience you may e-mail photos to [email protected] - label subject as “Fair Animal Photo”.
Building Strong and Vibrant New York Communities Cornell Cooperative Extension is an employer and educator recognized for valuing AA/EEO, Protected Veterans, and individuals with disabilities and provides equal program and employment opportunities. Please contact CCE of Westchester if you have any special needs
Youth’s Information Name: ________________________________
Age (on Jan 1st) _______________
Address: _______________________________________________________________ Phone Number: _______________________(cell)____________________________ Signature: ______________________________________ Date: _________________ By signing here you declare that the animal listed on this form will be cared for by the youth and is officially designated as his/her 4-H Project Animal as of March 19 of the current year. Parent/Guardian Information Name: _________________________________________________________________ Address: _______________________________________________________________ Phone Number: _______________________ (cell)_____________________________ Signature: ______________________________________ Date: _________________ 4-H Leader’s Signature ___________________________ Date: _________________ 4-H Educator’s Signature: _________________________ Date: _________________
This form must be completely filled out and on file with Cornell Cooperative Extension of Westchester County in order for youth to be eligible to exhibit animals at the Putnam County 4-H Fair, the Westchester 4-H Showcase, the New York State Fair 4-H youth animal classes, and if you are bringing your project animal to the Yorktown Grange Fair.
