2017 WAYNE COUNTY 4-H Horse Forms Packet

Transcription

1 Member s Name Club Horse Forms Packet This packet contains important Horse forms that are due June 1 st. It also includes the Special Request form that is due May 1 st. Please be sure to read the Horse Project Guidelines / By-Laws Packet and then complete the forms in this packet. Please return this packet completed and in tact without removing the staple in the upper left corner to the Extension Office. If you are submitting the special request form, it is permissible to go ahead and remove that form since it is due on May 1 st. If you need to add more Horse ID forms or more PAS Show Entry forms, it is acceptable to copy the forms and add them in. However, please turn in a completed packet with the forms in the same order as they are in this original packet and all stapled together! Please note: There are 2 copies of the Horse Photo Id and Horse Id (drawing / sketch) forms included in this packet since youth are permitted to show two equine animals. You may id more than 2 animals if you are not yet sure which animals you will be showing. If you have any questions in completing these forms, please contact your advisor or the Extension Office.

2 PERMISSION TO PARTICIPATE IN 4-H HORSE ACTIVITIES DISCLOSURE AND RELEASE OF CLAIMS I,, have chosen to participate in the Ohio 4-H Horse Program and its related horse activities. I understand that this participation will involve contact with horses and may give rise to a risk of physical injury. I am aware that:: A. Horses have a tendency to behave in ways which may result in injury, death, or loss to riders, or other persons in the immediate vicinity; B. Horses may react in an unpredictable way to sounds, sudden movement, unfamiliar objects, persons, or other animals; C. Riding a horse may give rise to a risk of injury from hazards arising from the surface or subsurface of the ground in which these riding activities occur; D. While in the vicinity of a horse or while riding a horse, I may be involved in a collision with another horse, another animal, a person, or an object; E. Other participants in the program may fail to maintain control over a horse or fail to act within their abilities, thus causing harm to me or other participants; and F. Other participants in the program may act in a negligent manner, which could result in harm to me. As parent or guardian I have discussed with my child the need to behave in a safe manner. I will make sure that my child wears appropriate clothing and footwear during horse activities. I further agree that my child shall be subject to the helmet policy. In consideration for the opportunity to participate in club, county, district and state 4-H horse activities and the use of services and facilities made available through these 4-H horse activities, I do release and forever discharge for myself and my heirs, executors, administrators, and assigns, the Ohio 4-H Horse Program professional and volunteer leaders, agents, The Ohio State University and its Board of Trustees, its administrators, faculty and staff, from all claims, demands, and causes of action for personal injury or any other damage which may arise out of or be in any way related to my participation in this activity or program. I understand that my child is not required to participate in any horse activity, but grant permission for him/her to do so, despite the possible risks. I recognize that by participating in these activities, as with any physical activity, my child may risk personal injury. I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in these activities, and that I assume any expense that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses. As a parent/guardian, I assume the same risk for myself, and other family members and friends present at these horse activities. Return to your local OSU Extension, 4-H Program Office By: Signed: (4-H Member) Date Signed: (Parent or Guardian) Date This form needs to be signed and on file for each youth participant in any 4-H horse program activity. The form needs to be signed each year and before a youth participates in the Ohio 4-H Horse Program Activities. Under Ohio law, Section of the Revised Code, an equine activity sponsor, professional, volunteer, participant or other person is not liable for an injury to or the death of a participant in the equine activities resulting from the inherent risks of equine activities. 4-H Equine Mandatory Helmet Use Policy All youth 19 years and under, participating in any 4-H equestrian activity, are required to wear properly fitted protective headgear which meets or exceeds current ASTM (American Society for Testing and Materials)/SEI (Safety Equipment Institute) standards with the chin harness securely fastened at all times while riding or driving an equine. It is the responsibility of the rider, or the parent or guardian of the youth participant, to make sure that the headgear worn complies with appropriate safety standards for protective headgear intended for equestrian use, and is properly fitted and in good condition. The Ohio 4-H Horse Program, Show Committees, Officials, Extension Personnel and Volunteer Leaders are not responsible for checking headgear worn for such compliance. The Ohio 4-H Horse Program, Show Committees, Officials, Extension Personnel and Volunteer Leaders make no representation or warranty, expressed or implied, about any protective headgear, and cautions riders that death or serious injury may result despite wearing such headgear, as no helmet can protect against all foreseeable injuries in equestrian activities. The Ohio 4-H Horse Program, Show Committees, Officials, Judges, Extension Personnel and Volunteer Leaders may, at his/her discretion, check a participant s protective headgear for proper standards. If the youth is found to be wearing unapproved, defective, or improperly fitted headgear, he/she will not be permitted to participate in riding or driving activities until proper headgear is acquired. Horse.osu.edu

3 Horse Photo Identification Form (Due to the Extension Office June 1 st ) 4-H Member s Name 4-H Club Horse s Name Please attach a 4x6 color photo of the left side view of your horse in the space below: Please attach a 4x6 color photo of the front (head view) of your horse in the space provided on the back of this form.

4 Please attach a 4x6 color photo of the front head view of your horse in the space below:

5 Horse Photo Identification Form (Due to the Extension Office June 1 st ) 4-H Member s Name 4-H Club Horse s Name Please attach a 4x6 color photo of the left side view of your horse in the space below: Please attach a 4x6 color photo of the front (head view) of your horse in the space provided on the back of this form.

6 Please attach a 4x6 color photo of the front head view of your horse in the space below:

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9 Horse Project Guidelines / By-Laws Receipt Form Please return completed forms to the Wayne County Extension Office by 4:30 pm on June 1 st no exceptions! I have received, read, understand, and agree to abide by all of the rules, deadlines, and other information contained in the 2017 Wayne County 4-H Horse Project Guidelines and By-Laws Packet. Member s Signature Date Member s Name (print) Club Parent / Guardian s Signature Date

10 P.A.S. Show Entry Form Please return completed forms to the Wayne County Extension Office by 4:30 pm on June 1 st no exceptions! Name Club Age Division Jr. Sr. Address City State Zip Phone Age as of January 1 Date of Birth Years in 4-H Parent/Guardian Name(s): Note: You may only try to qualify with one animal, which you must choose at this time. Horse Pony Horse or Pony Name: Select no more than 4 classes (including ground roping). Ground ropers must qualify in at least one other class to compete at State Fair. To qualify for State Fair a member must qualify in any 2 classes (ground roping plus one other class). Members can qualify and show in 3 classes at State Fair, plus ground roping, for a total of Sr. Western Showmanship 28. Jr. Small Equine Jumper 2. Jr. Western Showmanship 29. Sr. Western Horsemanship 3. Sr. Hunter Showmanship 30. Jr. Western Horsemanship 4. Jr. Hunter Showmanship 31. Sr. Western Pleasure* 5. Sr. Saddle Type Showmanship 32. Jr. Western Pleasure* 6. Jr. Saddle Type Showmanship 33. Sr. Ranch Pleasure* 7. Sr. Draft Showmanship 34. Jr. Ranch Pleasure* 8. Jr. Draft Showmanship 35. Sr. Trail 9. Sr. Hunt Seat Equitation 36. Jr. Trail 10. Jr. Hunt Seat Equitation 37. Sr. Trail In Hand 11. Sr. Saddle Seat Equitation 38. Jr. Trail In Hand 12. Jr. Saddle Seat Equitation 39. Driving Reinsmanship Light or Draft (all Ages) 13. Sr. Hunter Under Saddle 40. Ground Roping 14. Jr. Hunter Under Saddle 41. Sr. Western Riding 15. Sr. English Pleasure-Saddle Type 42. Jr. Western Riding 16. Jr. English Pleasure- Saddle Type 43. Sr. & Jr. Reining- Pattern C 17. Easy Gaited Pleasure (no trot-all ages) 44. Light Horse Driving (all ages) 18. Easy Gaited Equitation (all ages) 45. Light Pony Driving (all ages) 46. Draft Horse Driving (all ages) 15 Minute Break 47. Draft Pony Driving (all ages) 48. Pony or Jr. Poles 19. Sr. Hunter Hack 49. Sr. Poles 20. Jr. Hunter Hack 50. Pony or Jr. Stakes Race 21. Sr. Hunt Seat Equitation Over Fences 51. Sr. Stakes Race 22. Jr. Hunt Seat Equitation Over Fences 52. Pony or Jr. Keyhole Race 23. Sr. Working Hunter Over Fences 53. Sr. Keyhole Race 24. Jr. Working Hunter Over Fences 54. Pony or Jr. Barrels 25. Sr. Small Equine Hunter 55. Sr. Barrels 26. Jr. Small Equine Hunter 27. Sr. Small Equine Jumper * The exhibitor cannot show the same horse in Ranch Pleasure and Western Pleasure at the same show.

11 Horse Special Request Form All special requests for exceptions to the Wayne County 4-H Horse Committee By-Laws and/or other special accommodations for horse youth will be for one project year only and must be presented in writing via this form to the 4-H Horse Committee. Special Request forms should be turned in to the Wayne County Extension Office by 4:30 pm on May 1, H Member s Name: 4-H Member s Club: 4-H Member s Age as of January 1 st of the current year: 4-H Member s Address: Parent / Guardian s Name(s) Phone: List the 4-H member s horse s name(s) below (please list all horse name(s) registered to the member for this year Please describe what your special request is below (attach additional page if necessary): 4-H Member s Signature Parent s Signature Advisor s Signature