Market Lamb Quality Assurance - National Western Stock Show (Page 2 of 2) in pdf

EXHIBITOR VERIFICATION FORM

With this application, I verify that I have reviewed with the verifier, whose signature is provided below, the

practices of the Sheep Safety and Quality Assurance Program. ( ) Please return

one fully completed form for each Junior Exhibitor.

Exhibitor’s Name: _________________________________________________________________

Please print clearly.

Farm Name (If applicable)___________________________________________________________

Home Address____________________________________________________________________

City_____________________________________State__________________Zip________________

Telephone________________________________ Date of Birth______________________________

Social Security Number___________-__________-__________

Exhibitor’s Signature______________________________________

VERIFIER CERTIFICATION

(Extension Agent; VoAg Instructor; Veterinarian; or bona fide Quality Assurance Instructor)

I have discussed the exhibitor’s responses to the checklists. It is my professional judgment that he/she has met the

requirements of Sheep Safety and Quality Assurance. ( )

Signed______________________________________________Date___________________________

Name_______________________________________________Title___________________________

Please Print Clearly

Address____________________________________________________________________________

City_____________________________State_____________________Zip______________________

REMINDER: ALL SIGNATURES MUST BE COMPLETE.

THANK YOU

Complete history of all vaccinations/medications given to this animal while under control of the exhibitor:

ANIMAL’S

EXHIBITOR’S

TREATMENT

DATE

ID #

INITIALS

_________________________________________ ______________ ____________ ____________

Please supply additional records if necessary.

PLEASE BRING THIS FORM TO NWSS AT THE TIME OF PROCESSING

Market Lamb Quality Assurance - National Western Stock Show Page 2