Printable Version of Dog ID Form (Word)

Fallon County 4-H Dog ID 

To participate in county or state 4-H dog activities, this form must be on file at the Extension Office by June 1st. 

4-H MEMBER NAME: _______________________________________________4-H YEAR: ____________________ 
PHONE NUMBER: _________________________________________________________________________________ 
DOG’S NAME: ______________________________________ BREED/TYPE: ______________________________ 
DATE OF BIRTH: __________________ MALE NEUTERED MALE FEMALE SPAYED FEMALE 
WHO WAS THE BREEDER OF YOUR DOG: _________________________________________________________ 
THIS DOG IS MY PROJECT DOG FOR: OBEDIENCE HERDING
You may choose to attach a current vaccination record. 
RABIES 
(Every 2 Years)
DHLPP 
(Every Year)
Date Given 
 Date Expired 
 Product 
 Serial # 
Date Given 
 Date Expired 
 Product 
 Serial # 
Date Given 
 Date Expired 
 Product 
 Serial # 
I certify this dog is a 4-H project for this year and the above information is correct to the best of my knowledge. I also 
agree to follow both county and state guidelines pertaining to the dog project. 
Members: ____________________________________ Date: ____________ 
Parent/Guardian: _______________________________Date: ____________ 
YEAR MEMBER GUARDIAN
Fallon County Extension Office: P.O. Box 850; Baker, MT 59313 // Phone: (406) 778-711