Application for Animal Contact Exhibit Permit

Date:

Exhibit name:

Exhibit owner

Name:

Business name:

Phone:

Cell Phone:

Email address:

Mailing address

We will mail your acknowledgement to this address.

Street
CityStateZip

Physical address

Same as mailing address

Street
CityStateZip

Below, add entries for each fair at which you wish to exhibit.

Fair, dates, and exhibit

Fair name:

Begin date:

End date:

Exhibit type(s):petting zooother animal rides
baby poultryother
pony ride

Explain:
(if other)

I understand all of the exhibited animals must meet all of the requirements specified in the North Carolina Statues and Rules and Regulations of the North Carolina Board of Agriculture. I agree to be responsible for determining that each animal meets exhibition requirements prior to entry into the exhibition facility.

I agree to keep adequate records necessary to demonstrate compliance with all North Carolina Board of Agriculture Rules and Regulations and will provide these records on-site for inspection when requested by any authorized agent of the North Carolina Board of Agriculture.

I attest that I understand and agree to be bound by the terms and conditions outlined above.