Permission to Participate in the Oregon Dressage Society/ODS Youth/High School Dressage Lettering Program (pg. 1 of 2)

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1 Date: Permission to Participate in the Oregon Dressage Society/ODS Youth/High School Dressage Lettering Program (pg. 1 of 2) ATTN: (High School, Principal, Athletic Director, Activities Director) RE: Name/Grade Request to earn a club sport letter as a member of the Oregon Dressage Society (ODS) Youth/High School Dressage Program (endorsed by ODS and the United State Dressage Federation). HISTORY: In 2001, the Oregon Dressage Society (ODS) received approval from the Oregon Department of Education to have dressage recognized as a high school club sport for which students may receive a high school letter. The ODS Youth/High School Lettering Program has been alive and well since the first team formed in High School Dressage Clubs across the nation are recognized by their State as well as Federal Equestian Organizations. Dressage is an equestrian sport, and is part of the Olympic Summer Games. The ODS High School Youth/High School Lettering Program is endorsed by ODS and the United States Dressage Federation(USDF). Both award letterman pins and certificates specifically designed for each organization when students reach lettering requirements. The United States Equestrian Federation(USEF-a sister organization to the Olympic Committee), also recognizes students who are USEF members by awarding them with letterman pins and certificates. NOTE: This lettering program is NOT associated with the Oregon High School Equestrian Team, which many schools have that equestrian letter/pin award. How student s can participate in the ODS Youth/High School Lettering Program ~ 1) Your school can form its own Dressage Team and will have an ODS HS Team Coordinator who will be responsible for running the program for your school; or 2) For students who attend schools that do not have enough interested riders to form an ODS sponsored dressage club, the high school can release their student to another school who has agreed to host other school s student(s) as members of their team. To participate in this program a student (with parent/guardian signed permission) must: (a) obtain their schools written consent to form a team or join an existing team (b) the school must acknowledge that the student(s) are in good citizensip and academic standing (c) Be a member of ODS (for insurance purposes). (Insurance in not needed from the school) To further qualify for a high school letter, pins and certificates, the student must: a) remain acedemically qualified to participate in team sports b) compete at one ODS/USDF/USEF level High School Team Show per year and at least two ODS approved dressage shows per academic year c) obtain a test score of 60% or higher at Training Level or above at two or more ODS/ USDF/USEF recognized competitions per year d) Volunteer at the horse shows the student is competing at, or make up the volunteer hours need to provide proof to Team Coordinator

2 Pg 2 of 2: Permission to participate in ODS Lettering Program The Team Coordinator is responsible for monitoring and submitting verification of letter eligibility to the student s school at the end of each school year. RELEASE Our school would be interesting in forming a High School Dressage Club/Team sponsored by the Oregon Dressage Society. Please contact Gaye McCabe j-g.mccabe@juno.com Our school would like to continue being a host school for our ODS High School Team. Our school would like to continue being a host school for our ODS High School Team as well as for home schoolers and other public and private high school students. Our school will release this student to participate on another High School (host) Dressage Team. If the student qualifies to letter in dressage, our school will acknowledge this achievement. (The Dressage Club Coordinator will notify the student and school in writing when lettering requirements have been met.) Academic and citizenship verification that the above subject student is qualified to participate in club sports. I verify the student is qualified I verify the student is NOT qualified Name Date Title Phone Number Should you have additional questions, please contact Gaye McCabe **Student should submit this form plus all the forms attached to: Lynette Hammon SW Kramien Rd. Newberg, OR lynette@hevanet.com call/text

3 Oregon Dressage Society (ODS) Youth/High School Lettering Program Participant Code of Conduct; and Liability Release (pg 1 of 1) As a member of ODS Youth/High School Lettering Program I and my parent(s) or guardian(s) agree to honor the following statements: CONDUCT 1. I will maintain an academic standing high enough to be eligible to participate in high school sports. 2. I will maintain conduct at school and in my personal live that demonstrates good citizenship. 3. I will conduct myself in a manner that reflects well on the Dressage Program, the school I attend and the team I represent by being thoughtful and respectful to my horse/s, team members, volunteers, and all other participants. 4. I will take responsibility for personal growth by developing responsibility, loyalty, pride, integrity and commitment as a student and an athlete. 5. I agree not to use alcohol, tobacco or non-prescription drug during club eventsor in my personal life. 6. I will dress appropriately and safely for club events and activities. When riding (whether for practice, show, training or fun) I will wear acceptable shoes, (hard shoes with heals), use appropriate and safely/properly adjusted tack, and to wear a safety approved riding helmet. 7. I will be courteous, display good manners to all and will use appropriate and respectful language to all, with no swearing. 8. During all club events, during all meets/shows, and during all other activites, I will observe established hours, keep the person in charge of club members informed of my whereabouts, and obtain permission from the person in charge of club members when I will be out of their sight. LIABILITY RESONSIBILITY 1. I understand that I must be a current ODS member to participate on a team. I understand that I am solely responsible for myself/child in preparing for, getting to and returning from ODS approved/insured activities. If I want to schedule an ODS activity I know that I need to obtain insurance through the ODS office. 2. I understand and take personal responsibility for handling and riding horses that can be dangerous. 3. I understand the need for the person in charge of club members to know of my whereabouts at all times - not only because of the known dangers of equestrian sports, but also of society in general. Many places where shows and events are held may have unpredictable and possibly dangerous people at the show/event site. 4. I understand and accept the responsiblity for all costs associated with participating as a club member, to include my own health care/insurance, and for the health and care of my horse(s) owned, leased or borrowed. 5. I will hold my school and host club school, ODS, club advisors, coaches, and/or those assisting with, and participating in club activities harmless and not liable for any injury (or worse) that may occur to myself or the horse(s) I will use while participating in events associated with being a member of the (name of club). 6. I will complete the attached Medical Information & Release form, and if there is an emergency event and my parent/guardian is not immediately available, my parents/guardians give permission to emergency treatment as seen fit. Member s Signature Parent/Guardian s Signature Date Date

4 Oregon Dressage Society (ODS) Youth/High School Lettering Program Participant Medical Information and Release (pg 1 of 1) PARTICIPANT: (First) (Middle Initial) (Last) ADDRESS: OR (Street Address) (City) (State) (Zip) (Date of Birth) (Home &/or Cell #) ( address) PARENT/s or GUARDIAN and EMERGENCY CONTACT/S (in order to be contacted): Name/Relationship/phone # s HEALTH STATEMENT: Name and phone # of physician: Name of medications being taken: Types of allergies, dietary restrictions &/or other health related issues that should be known: CIRCLE CORRECT ANSWER & COMPLETE ADDITIONAL INFORMATION Yes / No - Diabetic Yes / No - History of respiratory illness Yes / No History of seizures Yes / no - History of heart related issues Allergies to: ; typical reaction Date of last tetanus shot: List any medical conditions and/or accommodations that may be needed in order to participate as team member: As a parent or guardian, if my child needs urgent medical attention and I am not immediately available a reasonable attempt will be made to contact me. However, in such an event, if I cannot be contacted in a timely manner, I give permission to have medical personnel called, ambulance transportation to a medical facility, and to have medical treatment administered which is determined necessary to include release of medical records, hospitalization, emergency treatment (which could include x-rays, CAT scans, anesthesia, emergency surgery, etc.) to protect my child s life prior to my notification. I agree to assume all financial, legal and liability, obligations incurred whether or not covered by my personal insurance coverage(s). (Signature of Parent/Guardian) (Date) I (club member s name), have read this medical information form and understand it to the best of my ability.

5 School Year ODS YOUTH PROGRAM/HIGH SCHOOL DRESSAGE MEMBERSHIP FORM (pg. 1 of 2) Your ODS Youth Program team leaders are dedicated to helping youth interested in dressage whether you are interested in learning more about dressage, or you have ambitions of competing for national and/or international awards and programs Student/Horse Info Name Phone Do you check ? Address School Grade Yrs riding Yrs riding dressage Level schooling Lvl Showing Horses Name Breed Hrs Age Do you have a current Dressage instructor Y N Name Name of barn Parent/guardian Info: Name (s) Phone (s) address Mailing address I AGREE and acknowledge the Oregon Equine activities limited on liabilities law : (initial) INTERESTS/GOALS: Please check what other equestrian activities you participate in, and how many years; and/or equestrian activities you plan on participating in, or are interested in: 4-H. Number of years ; or do you plan to join Yes, No Which county? OHSET (Oregon HS Equestrian Team). # years ; plan to join Yes No Team? Pony Club. Number of years ; or do you plan to join Yes No Team? Are you interested in participating in dressage clinics Y N

6 Other dressage/equestrian related programs, activities (i.e. trail riding club, drill team, etc.): Youth Info - Pg 2 of 2 1. Are you interested finding out more about, and perhaps applying for the Emerging Dressage Athlete Program? Yes No Maybe Are you interested in finding out more about the new Region 6 Young Rider program? Yes No Maybe 3. Are you interested in finding out more about the North American Junior & Young Rider Championships? Yes No Maybe Jr/YR - Jodi McMaster is the current coach/mentor/leader for this program. This program is designed for the most serious and dedicated young equestrians who want to try out for a position on the Region 6 team. The Region 6 team will compete against all riders in North America who qualify. It is kind-of-like a junior version of the Olympics trials, and the Olympics. **What would you like to get out of OR would like to see more of in your HS Dressage Club? Please feel free to attach a continuation page to answer the above questions. The more information we have, the better we can help.