Fulton County Fair                                       Office Use:  Exhibitor # _______________                                                                                                       ALL LIVESTOCK ENTRIES ARE TO BE MAILED TO:    888 LWE McConnellsburg, PA 17233        (717) 552-9543          Pd ________________
COMPLETE SECTION BELOW ENTIRELY              Fair July 28th to Aug. 3rd, 2024               Livestock entries close July 1, 2024 NO EXCEPTIONS
Exhibitor _______________________________________   PA County __________________   Telephone ___________________________________
Address ________________________________________   Jr. exhibitor date of birth ____________ Jr. exhibitor parent ________________________  
   Exhibitor carries below 4H / FFA projects in which 4H / FFA Club: __________________________________________________
Dept#	Sec#	Class#	Class name	This item is Youth / Open / 4H / FFA	breeding-meat-
market - dairy	Housed at:	# of pens needed	 Entry fee 	

									

									

									

									

									

									

									

Animal Owner or Caretaker’s Verification of Veterinarian-Client-Patient Relationship
I am the undersigned, hereby verify the following:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              I am the owner/caretaker (circle one or both) of the following animal(s), identified by ear tag, tattoo, leg band, etc. (A copy of the “Certificate of Veterinary Inspection” may be    attached to meet this animal identification requirement. Use additional sheets as necessary.)
ANIMAL ID 
                         (i.e. ear tag, tattoo, leg band, brand)	REGISTRATION NAME OR DESCRIPTION	

		

		

		

		

		

I have established an ongoing “Veterinarian-Client-Patient Relationship” for the animal(s) described in the preceding paragraph with ________________________________________   (print name), a licensed practitioner of veterinary medicine having the following business address: ____________________________________________________________________
I understand this ongoing “Veterinarian-Client-Patient Relationship” to be a relationship in which the veterinarian named in the preceding paragraph has assumed the responsibility for making veterinary medical judgments regarding the health of the animal(s) described above and the need for veterinary medical treatment of said animal(s), and in which I, owner and/or caretaker of the animal(s), have agreed to follow the instructions of the veterinarian in relation to zonotic diseases.
I verify the foregoing to be accurate. I make the foregoing statement subject to the penalties of 18 Pa.C.S.A. § 4904 (relating to unsworn falsification to authorities). In witness of this, I have signed and dated this verification below.
_____________________________________________________________________           ________________________________________________________________________ Signature of Owner/Caretaker                                                                   Date                                                        Printed Name Of Owner / Caretaker
____________________________________________________________________________________________________________________________________________________     Address of Owner/Caretaker