2024 Dog Registration Form
Email below will be the email the registration receipt will be sent to
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Email *
Species
*
Member's Last Name *
Member's First Name *
4-H Club Name
*
Class *
Special Considerations
Education One
*
Required
Education Two
*
Required
Work Bee
*
Required
4-Hers Date of Birth
*
MM
/
DD
/
YYYY
4-H Age (as of 01/01/2024)
*
4-Hers Street Address
*
4-Hers City
*
4-Hers Zip Code
*
Primary E-Mail Address
*
Secondary E-Mail Address
Parent(s)/Guardian(s) Names
*
Primary Parent Phone Number
*
Secondary Parent Phone Number
Intentionally Left Blank
Intentionally Left Blank
Is the Dog housed at the above address?
*
If no, please provide the contact name, phone number, and address for the location that the dog project is housed at?
CLOVERBUD and SHOW ONLY: Are you showing someone else's dog project?
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If yes, please provide the name of the 4-H project owner:
Dog Registrations are due: June 3, 2024
A copy of your responses will be emailed to the address you provided.
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