| Exhibitor Health Declaration As an exhibitor at the_____________________________ show, I hereby certify that to the best of my knowledge, the following statements are true. If any statement is not true, I will check “no” in the space provided after each statement. I understand that protecting the health of all entries is a major responsibility of all poultry shows and that my entry could be rejected if there are concerns about the health of my entry. If you have any questions regarding these questions or this form, please refer them to the Show Secretary PRIOR to the deadline for registration. This form should be returned to the show secretary with your entry and fees. 1) I certify that no birds in my flock have ever been vaccinated by the CEO type of Infectious Laryngotracheitis vaccine (causes inoculated birds to become carriers). Other forms of ILT vaccines are permitted. I also certify that I have not vaccinated any birds in my flock with any kind of live or modified- live vaccine in the thirty days prior to this show. NO____ If you answered ‘no’, please explain: 2) I certify that my flock contains no birds that were shipped and/or transported in any other way out of or through an area that has been under quarantine in the last sixty days or that was under quarantine at the time the birds were transported. NO____ If you answered ‘no’, please explain: 3) I certify that to the best of my knowledge, no birds in my flock were showing signs of illness at the time that this entry was submitted. This includes symptoms as minor as nasal discharge or a drooped tail. (A dropped tail, as in touching the ground, can be a symptom of a highly virulent strain of Infectious Bronchitis, which is highly contagious and can spread through a building within 24 hours. Dropped tail does not apply to those breeds where a low tail is required.) NO____ If you answered ‘no’, please explain: 4) I certify that each bird to be exhibited has been owned by me and in my direct custody for the previous 30 days. I also certify that any previous owner has assured me that the bird was not vaccinated with the CEO type of ILT vaccine. NO____ If you answered ‘no’, please explain: _______________________________ ____________ Exhibitor signature Date If you have further questions, please contact Lou Horton at
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
or
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
. | 
