4-H Health Certificate Event 2022 Please fill out and submit this form prior to your appointment. Parent Name* First Last Email* Enter Email Confirm Email Phone Number*Best way(s) to contact you* Text Phone Call E-mail Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Premise IDIf you have a premise ID, please enter it here. Name of Child*This will be the name that appears on the health certificate. If you need separate certificates for each child, please submit a separate form for each with their animal(s) listed. First Last Fair Destination*Example: Clark Co 4-H, Edgar Co Fair, etc. Location of Animals (if different from address above)List*Animal Name/Farm ID#Official ID #1 (REQUIRED)Official ID #2 (if applicable)Age or DOBSex (M, F, or CM)SpeciesBreed Add all the animals your child is showing to this list. Each animal listed MUST HAVE OFFICIAL ID placed *prior to* the exam. If they do not have it, a CVI cannot be issued for the animal. Official ID is a USDA metal or scrapies tag, USDA button tag or microchip. IF ear tag or notches are used as official ID, they MUST be accompanied by registration paperwork that lists the ear notch or tattoo. (You will have to bring this with you to the CVI event and the fair.) If you have any questions about whether your animal has official ID, please contact the 4-H office. To add multiple animals, click the plus sign at the end of the row to add additional lines.Required StepsPlease make sure you have all of the following complete before your appointment time. Have a confirmed appointment time made with Jennifer Bishop from 4-H All animals have official ID All horses have a current Coggins and have a copy submitted through this form Submit this information form well before the appointment Upload File(s)Copy of Coggins Test (equine), registration papers, etc. if needed Drop files here or Select files Max. file size: 256 MB. Anything additional we need to know?
