4-H Year ____________

APPLICATION FOR LIVESTOCK HOUSING

This application is for housing of St. Joseph County 4-H livestock animals at a location other than 4-H'ers

 primary residence.

THIS FORM DUE IN THE EXTENSION OFFICE BY JUNE 1

Check below which species this application is for:

Beef ______    Dairy Beef _____    Goats _____    Poultry _____   

 Rabbits _____ Sheep _____ Swine _____

* A different form must be completed for each species.  Each year a new form must be completed.

Member's Name ________________________________________________________________

Member's Address ______________________________________________________________

Grade in School ________Years in this Project __________4-H Club ______________________

Name of Person housing animals ____________________________________________________

Address of where animals are housed ________________________________________________

How far from your house is this? ____________________________________________________

Relationship of person housing animals to 4-H member (Grandparents, cousin, friend, etc.)

_____________________________________________________________________________

Why are your animals being housed here, instead of at your home? _________________________

_____________________________________________________________________________

Animals will be housed here from (date) ____________________ to _______________________

How often will you, the 4-H'er be able to take care of these animals while you are in school?

_____________________________________________________________________________

Once school is out, will you be living at the address where the animals are?  If not, please answer the

next question.__________________________________________________________________

Once school is out, how often will you be able to care for your animals? _____________________

_____________________________________________________________________________

Other comments ________________________________________________________________

_____________________________________________________________________________

Feel free to use the back of this form to provide more information

Signature of 4-H Member _________________________________ Date ___________________

Signature of Parent/Guardian _______________________________ Date ___________________

Signature of Person Where Animals are Housed ________________  Date ___________________