4-H 516
Do not write in this space.
Exhibit No. _____________
1983 INDIANA 4-H HORSE & PONY OWNERSHIP. ENROLLMENT AND ENTRY FORM
It is important to be accurate and complete. Any form not completely filled out may prohibit you from showing at State Fair. Therefore, read the instructions on the back of this form. You are making 5 copies so press hard.
Member’s Name
Date of Birth
Month Day Year
Complete Mailing Address
__________________________________________________________________________________________________________________________
R.R., Box, Road Number, Street, Apt., etc.	Town	    State	Zip Code
County _________________________ Telephone (____________)________-___________ Yr. in Project ___Yr. in 4-H _______________
Where a member
Indicate all markings, colors, scars and brands on the diagram (or attach snapshots of the right and left sides of your 4-H animal). Write a description of colors and markings. _______________________________________________________________________________________________
(Animals measured unshod and later shod must be remeasured and marked on the enrollment form.) Animals will be measured at random at the State Fair.
Complete this block when you are making a State Fair entry. Section No. Class Name
Halter (Enter only one section)
Performance (Enter only one section) Showmanship (only one area & one county winner per section)
Costume
Color Guard
Weanling (see back page)

Date_____ Signature of 4-H member verifying accuracy____________________________
Date_____ Signature of 4-H parent verifying accuracy_____________________________
Date_____ Signature of Extension Agent verifying membership_______________________
Entry qualified at area____or county show	(check one only)
Complete this block for enrollment as outlined in the instructions on the back of this form.
List the Breed or Grade_____________  Identification No. (if registered)______________
Horse’s Name
Animal Birthdate Club (in which you are a 4-H member)
    Mare     Gelding     Foal     Mare & Foal (Circle one)
I hereby certify that I am the owner or lessee (circle one) of this animal and that it is in my personal possession and under my daily care.
Date_____ Signature of 4-H member verifying completeness and accuracy.___________________
Date_____ Signature of 4-H parent verifying completeness and accuracy._____________________
Date_____ Signature of 4-H Leader_________________________________
Date_____ Signature of Extension Agent verifying membership._________________________