Youth Basic Dog Obedience Training Registration Form

							                           4-H Youth
                  Basic Dog Obedience Training
                                    Registration Form


Handler’s Name:                                                    Grade:


Address:                                                           Phone #:


City:                                      State:                  Zip Code:


4-H Club (youth MUST be in 3rd grade & enrolled in Jackson County 4-H):


Have you trained a dog before? No                   Yes
                                                                      (Please explain)


Is there anything else we should know about you or your dog?




Can you tell us any funny or interesting stories about your dog?




Would you (parent) be willing to help with any of the following?


               Painting/upkeep of agility equipment
               Moving of obedience/agility equipment
               Baking of treats for a fun night
               Help at the Jackson County Fair
               Telephone caller
               Dog Committee member
                          4-H Youth
                 Basic Dog Obedience Training
                              Canine Medical Information
                         (To be completed by your Veterinarian)

Owner's Name:

Dog's Name:                                                             Breed:

Date of Birth:
      Male:              Female:                     Neutered/Spayed? Yes                  No

Vaccination Record:           Rabies                                 Tag #
                              *DHLPPCV                               *Circle if 1st or 2nd vaccination.

Parasites:    Heartworm Test                                    Positive              Negative
              (As required by your veterinarian)


   My dog has been on heartworm preventative during the mosquito season?
                                                                        Yes              No

   My dog has been on heartworm preventative year round? Yes                             No

      Dog Committee recommends Heartworm test be performed and
      preventative Heartworm medication April through November.


   Internal Parasites: Negative                    Positive             Wormer Use
   (Stool check or broad spectrum wormer as required by your vet.)   Type

   External Parasites: Negative                    Positive          Type


General Health:



TOENAILS MUST BE TRIMMED.



          Veterinarian's Signature                                     Date


Please carefully read the information on the reverse side of this form.
Your signature is required on the reverse side of this form.
        Dog Obedience Training Agreement
      I understand that participation in a Dog Obedience class is not without risk.

This risk may be to myself, a guest, or my dog.

      According to Wisconsin Statute 174.02, “the owner of a dog is liable for the full

amount of damages caused by the dog injuring, or causing injury to a person,

livestock, or property.”

      My signature on this application indicates that I understand there may be risks

involved in participating in a Dog Obedience class, and that I am solely responsible

for any actions of my dog, and for any damages or injuries caused by my dog,

according to Wisconsin Statute 174.02.




      Signature of Legal Guardian if not an adult                      Date




        Dog Obedience Training Agreement
      I understand that participation in a Dog Obedience class is not without risk.

This risk may be to myself, a guest, or my dog.

      According to Wisconsin Statute 174.02, “the owner of a dog is liable for the full

amount of damages caused by the dog injuring, or causing injury to a person,

livestock, or property.”

      My signature on this application indicates that I understand there may be risks

involved in participating in a Dog Obedience class, and that I am solely responsible

for any actions of my dog, and for any damages or injuries caused by my dog,

according to Wisconsin Statute 174.02.




      Signature of Legal Guardian if not an adult                      Date