4-H Members Record Dog Project Template printable pdf download

4-H Members Record Dog Project Template

4-H Member’s Record

Dog Project

Member’s Name ____________________________________

Address ___________________________________________

Attach a photo

Age_____ Year of Birth_________Month _______Day______

of you and your

Name of parent or guardian ___________________________

dog in this space

Name of club or group _______________________________

Name of dog project leader ___________________________

Leader’s occupation _________________________________

Number of calender years in 4-H Work including this year __________________________________

List other projects carried this year _____________________________________________________

Information About Your Dog

My dog’s name ________________________________________________ Sex _________________

❑ Purebred

❑ Crossbred

Breed ______________________________________________

❑ American Kennel Club

❑ American Field

❑ Other

Is your dog registered in

Dog’s age ___________ Year of birth ____________ Month _______________ Day ____________

Vaccination Record and Dates

❑ Distemper ____________________ ❑ Leptospirosis ______________________

❑ Hepatitis _____________________ ❑ Rabies ___________________________

❑ Other ____________________________________________________________

(specify type, purpose, etc.)

Parasite Control Records and Dates

(specify species and veterinary treatment, if any.)

❑ Internal ________________________________ ❑ External ______________________________

Date project was started______________________________________________, 20_______

Date project was completed___________________________________________, 20_______

4-H Members Record Dog Project Template