Animal Wellness Form

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Date:
Animal Wellness
This document must be submitted to the official on site Wisconsin State Fair Veterinarian before an animal
receives treatment at Wisconsin State Fair.
Wisconsin State Fair Contact Info: 414.266.7052 (office) – Fax: 414.266.7057 or
Exhibitor Name: _______________________________ Contact number while at Fair: ______________________
Stalling/Barn Location:________________________________
Circle:
Junior
Open
Species (circle): Beef
Dairy
Goats
Horses
Miniature Donkey, Donkey, Mule
Poultry
Rabbit
Sheep
Swine
Animal Gender:
Female
Intact Male
Castrated (ie..gelding, steer, wether, barrow)
Animal Identification and pertinent information (Ear tag, Registration Number, etc.):
_____________________________________________________________________________________________
Reason/Diagnosis for treatment:__________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
**This section must be completed by ALL exhibitors wishing to medicate his or her animal at the Fair.**
Treatment (Product Name) to be administered: ______________________________________________________
Method of administration: (circle)
Subcutaneous
Intramuscular Oral
Intravenous
Topical
Labeled Product Dosage per treatment: ____________________________________________________________
Treatment Frequency: __________________________________________________________________________
I agree to administer and follow the above stated treatment plan. All treatments will occur in the approved
Wisconsin State Fair designated treatment areas. I understand failure to follow this plan may result in
disqualification, forfeiture of awards/premiums and/or loss of future Wisconsin State Fair participation.
Exhibitor/Parent Signature: ___________________________________________ Date: _____________
**For prescription treatments only, please have prescribing veterinarian complete this section PRIOR to the Fair.**
Prescribing Veterinarian: (Print Name) __________________________Clinic or Affiliation:_________________________
Contact information of prescribing veterinarian if on site Wisconsin State Fair Veterinarian needs any additional
information on the prescribed treatment plan: Cell phone:__________________Email:____________________________
I have prescribed the above noted treatment plan and believe it is appropriate for an animal entering a competition. I do
not believe this treatment plan provides any performance enhancement benefits if administered as noted.
Prescribing Veterinarian Signature: ______________________________________________ Date: __________________

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