2019 Supplement for Participants

Transcription

1 Southeast District 4-H Horse Show 2019 Supplement for Participants Please duplicate and share with Leaders, Parents & Exhibitors. DATE: June 2, 2019: Ranch Classes, Roping Classes Registration 12:00 noon; Events Start 2:00 p.m. June 3, 2019: Trail, Western Riding, Speed Events, English Classes Registration 7:30 a.m.; Events Start - 9:00am June 4, 2019: Halter, Showmanship, Western Pleasure, Western Horsemanship, Reining Registration 7:30 a.m.; Events Start - 9:00am LOCATION: Pontotoc County Agri-Plex, Ada ENTRY FEE: General entry fee of $20.00 plus $5.00 per class entered. (No refunds will be made after the late entry deadline unless the class is canceled.) Entries must be postmarked by April 30, Late entries will be accepted between May 1 st and May 20 th with an additional fee of $ Send entry forms and fees to: Southeast District Extension Office, P.O. Box 1378, Ada, OK Make checks payable to the OSU Southeast District Extension Office and attach to entry form. ELIGIBILITY REQUIREMENTS TO ENTER SHOW: To be eligible to participate at district and state 4-H qualifying horse shows, youth must be an Oklahoma 4-H member and meet the requirements, including those for enrollment, participation and minimum and maximum age as defined in the Oklahoma 4-H Membership Policy, September 1,2018- August 31, Included in the 4-H membership policies are requirements that youth must be a member for 30 days prior to participating in contests beyond county level. For district and state qualifying horse shows, youth must be a member a minimum of 30 days prior to the show and a member at time that entry is due. Entry deadline may cause minimum time of membership to be increased beyond 30 days prior to the district show. For youth of minimum age, this requires youth to be 8 years old AND in 3 rd grade by September 1, 2018 and enrolled 30 days prior to time entry is due. AGE DIVISIONS: Junior Age Division 3 rd, 4 th, and 5 th grade on September 1, 2018: Must be an Oklahoma 4-H member that is 1) a minimum of 8 years old AND in 3 rd grade as of September 1, 2018; must be an ACTIVE member in 4-H Online by April 30, Intermediate Age Division 6 th, 7 th, and 8 th grade on September 1, 2018: must be an ACTIVE member in 4-H Online by April 30, Senior Age Division 9 th, 10 th, 11 th and 12 th Grade on September 1, 2018: must be an ACTIVE member in 4-H Online by April 30, 2019.

2 In classes where there are only 2 age divisions, they will be: Juniors 3 rd 7 th grade as of September 1, 2018 Seniors 8 th 12 grade as of September 1, 2018 RULE CHANGES: All rules changes in the State Horse Show Rule Book are underlined. It is the responsibility of the 4-H member, volunteers and parents to review the rules, be familiar with the rules changes and abide by those rules. HEALTH PAPERS: Horses entering District Horse Show must have a current negative Coggins Certificate that is valid through the District Show (June 4, 2019). A legible copy of the negative Coggins certificate must be submitted with registration. Horses without a current negative Coggins Certificate will not be allowed to show or be stalled on the show grounds. Coggins papers will still be checked at the show as required by state law. Bring them with you to the Show! STALLS: Stalls will be available for $20 per day or if renting a stall for all three days, the cost will be $50. Participants are encouraged to sign up and pay for stalls in advance on their registration form. SHAVINGS: WILL NOT be available for purchase at the show. Contestants must bring their own shavings. It is recommended that you put 2 bags of shavings per stall and if staying more than one day, bring three bags per stall to make sure stalls have enough shavings for the entire stay. RV RENTAL SPACES: There will be RV rental spaces available at the Horse Show for a fee of $25 per day. Participants are encouraged to sign up and pay for RV rental in advance on their registration form. RV spaces are on a first come-first served basis. DO NOT CALL THE PONTOTOC COUNTY AGRI-PLEX TO RESERVE AN RV SPACE! CONCESSION STAND: Pontotoc County 4-H will be hosting a concession stand at the Agri-Plex on Monday and Tuesday. Please make an effort to support their fundraising by purchasing your food and drinks at the show! HORSE SHOW T-SHIRTS: Horse Show participants will receive as a part of their registration a t-shirt. Other family members or friends may order additional shirts at a cost of $15 per shirt. Shirts must be pre-ordered on the 4-H ers registration form and cost included in the total registration fee. CHECK-IN POLICY AT SHOW: Each Exhibitor will be required to bring their horse and Coggins to the area outside of the Registration Station for check-in. Upon approval of Coggins, you will then be given a Coggins Release Slip to take to the Registration Station to be issued your Contestant Number(s) and other materials. TWO HORSE USE RULE AT SHOW: At District and State Shows, each contestant may enter two horses. Those horses must be shown and/or ridden by that contestant only. A contestant or a horse cannot enter the same class twice. Youth will be allowed to show two mares or two geldings in halter, as long as the horses are in different age classes.

3 RULE BOOK: 2019 District and State Horse Show Rules are available online at: SUBSTITUTION RULE FOR DISTRICT HORSE SHOW: Exhibitors may enter and show up to two horses, but the specific class to be entered must be declared on the entry form for each horse. Substitutions may be allowed, under the following conditions: Up to 4 horses may be listed on the Horse Ownership and Verification Form. Horses listed on that form are the only eligible horses that can be used for substitution. Leased horses must also have the lease agreement attached to the Horse Ownership and Verification Form. Under no circumstances may any horse which is withdrawn from any class and replaced by a substitute compete in any subsequent class for the remainder of the show. A substitution fee of $50 per horse will be charged regardless of whether substitutions are made prior to the show or at the show. HORSE OWNERSHIP/MEMBERSHIP VERIFICATION FORM: The horse must be owned and certified as a 4-H project by May 1 of the year shown. All members participating in the District and State Horse Shows must have completed the Horse Ownership and 4-H Membership Verification Form. If ANY horse you have listed on the Horse Ownership/Membership Verification Form is leased, you must attach a copy of the lease agreement with the signature of the 4-H member and parent or guardian. The District Show Committee will certify all entries for the District and State Show. PLEASE ATTACH A COPY OF YOUR HORSE OWNERSHIP AND 4-H MEMBERSHIP VERIFICATION FORM TO YOUR ENTRY FORM. POLICY AGREEMENT/RELEASE OF LIABILITY FORM: This form is required in an effort to ensure the safety and liability of all involved. This must be completed and signed by both the contestant and his/her parents or guardian and attached to your entry form. APPEALS COMMITTEE: The State Horse Show Rules and Regulations will apply to the Southeast District 4-H Horse Show except as outlined in this supplement. It is the responsibility of contestants, leaders, parents and Extension staff to be familiar with the State Horse Show Rule Book and District Horse Show Supplement. The Appeals Committee is to receive and act upon any protest arising out of any event. The District Horse Show Committee adopted the rule that videos will not be considered as part of any appeal made to the appeals committee. A protest must be filed in writing accompanied with a $ cash fee immediately upon conclusion of the class. If the Appeals Committee upholds the protest, the deposit shall be refunded. If the Appeals committee does not uphold the protest, the deposit shall be forfeited to the Horse Show Fund. If an exhibitor or associated parties are guilty of unsportsmanlike conduct or misbehavior during the show or in the arena, the show management may suspend exhibitor s right to participate in future classes at the show as deemed appropriate. ONLY SHOW OFFICIALS ARE ALLOWED IN THE ANNOUNCER STAND. HIGH POINT CALCULATIONS: High Point calculations are based on one (1) horse, (1) rider. Points are awarded on each placing 1 st 10 th place. All-around High Point will be presented to the Beginning, Intermediate and Advanced Champion and Reserve Champion for Speed, Western and English. Champion and Reserve Champion awards will also be given for the two age divisions in the Ranch Classes. Maximum points given are up to 10 per class. 10 points will be given to the 1 st place winner.

4 If 10 or more participants are in the class, we will follow this chart: 1 st - 10 points 6 th 5 points 2 nd 9 points 7 th 4 points 3 rd 8 points 8 th 3 points 4 th 7 points 9 th 2 points 5 th 6 points 10 th 1 point If less than 10 participants are in a class, 1 st place will receive the same number of points as participants in the class. For example, a class with 5 participants would follow this chart: 1 st 5 points 4 th 2 points 2 nd 4 points 5 th 1 point 3 rd 3 points OTHER RULES: A. THERE WILL BE AN ORIENTATION MEETING EACH DAY BEFORE SHOW BEGINS FOR YOUTH AND ADULTS: JUNE 2 1:30 PM; JUNE :30 AM ; JUNE :30 AM. DO NOT BRING HORSE TO ORIENTATION MEETING. B. There will be no minimum number of contestants required for Roping classes and Hunter Hack classes to be held. C. In all Hunt Classes a Safety Helmet with harness must be worn when schooling or exhibiting over fences while on the show grounds. D. No Exhibitor may be tied, buckled, or fastened in the saddle in any manner or by any means while on the show grounds. Safe, humane animal handling and riding practices are to be prioritized and followed at all times. E. Ribbons will be presented through 10th place in all classes. F. Patterns for specific classes will be posted the day of the show and each exhibitor packet will include a copy of the patterns. G. Protective eyewear will be permitted. H. Tie breakers will be broken by the rules stated in the 2019 State Horse Show Rule Book. I. High Point Awards tabulation does not include halter classes. QUALIFICATIONS FOR ENTERING STATE HORSE SHOW AND SOUTHERN REGION 4-H SHOW IN GEORGIA: Participants qualify for a State Show class by EXHIBITING AND COMPLETING A QUALIFYING RUN IN THE CLASS ENTERED/PLACED AT THE DISTRICT SHOW. ONLY CLASSES ENTERED AT THE DISTRICT SHOW MAY BE ENTERED FOR THE STATE SHOW. A DQ or 0 score means exhibitors do not advance to State. Youth interested in showing at the Southern Region 4-H Horse Show in Georgia in July may participate in any class they wish as long as they participated in the 2019 District Horse Show and placed in at least one class. Application for State Horse Show Entry: When confirmation letter is sent for the District Horse Show, we will provide State Horse Show Entry procedure information.

5 2019 DISTRICT HORSE SHOW SCHEDULE Pontotoc Agri-Plex Ada, OK SUNDAY, JUNE 2, 2019 Registration: 12:00 noon Orientation meeting: 1:30 p.m. (do not bring horses to orientation!) Events Start: 2:00 p.m. Classes will perform in the order listed below Events will be held in Large Animal Barn 42. Ranch Horse Trail (Junior, 3-7 grade) 43. Ranch Horse Trail (Senior, 8-12 grade) 40. Ranch Horse Riding (Junior, 3-7 grade) 41. Ranch Horse Riding (Senior, 8-12 grade) 44. Ranch Roping (Junior, 3-7 grade) 45. Ranch Roping (Senior, 8-12 grade) 46. Working Cow Horse/Boxing Only (Junior, 3-7 grade) 47. Working Cow Horse/Boxing Only (Senior, 8-12 grade) 1. Breakaway Roping (Junior, 3-7 grade) 2. Breakaway Roping (Senior, 8-12 grade) 3. Calf Roping (All Ages) MONDAY, JUNE 3, 2019 Registration: 7:30 a.m. Orientation meeting: 8:30 a.m. (do not bring horses to orientation!) Events Start: 9:00 a.m. Classes will perform in the order listed below Events will be held in Big Red Barn 28. Trail (Junior) 29. Trail (Intermediate) 30. Trail (Senior) 37. Western Riding (all Ages) 4. Barrel Race (Junior) 5. Barrel Race (Intermediate) 6. Barrel Race (Senior) 7. Pole Bending (Junior) 8. Pole Bending (Intermediate) 9. Pole Bending (Senior) 10. Stakes (Junior) 11. Stakes (Intermediate) 12. Stakes (Senior) NOTE: There will be a 30 minute tack and equipment change between the Speed classes and the first Hunter Under Saddle class.

6 ENGLISH CLASSES 13. Hunter Under Saddle (Junior) 21. Hunter Under Saddle (Intermediate) 22. Hunter Under Saddle (Senior) 23. Hunt Seat Equitation (Junior) 24. Hunt Seat Equitation (Intermediate) 25. Hunt Seat Equitation (Senior) 26. Hunter Hack (Junior 3-7 grade) 27. Hunter Hack (Senior 8-12 grade) TUESDAY, JUNE 4, 2019 Registration: 7:30 a.m. Orientation meeting: 8:30 a.m. (do not bring horses to orientation!) Events Start: 9:00 a.m. Classes will perform in the order listed below Events will be held in Big Red Barn 14. Halter Mares -- 5 years and younger 15. Halter Mares 6 years and older 16. Halter Geldings 5 years and younger 17. Halter Geldings 6 years and older 18. Showmanship at Halter (Junior -- English & Western Combined) 19. Showmanship at Halter (Intermediate English & Western Combined) 20. Showmanship at Halter (Seniors English & Western Combined) NOTE: There will be a 30 minute tack and equipment change between the Halter classes and the first Western class. WESTERN CLASSES 31. Western Pleasure (Junior) 32. Western Pleasure (Intermediate) 33. Western Pleasure (Senior) 34. Western Horsemanship (Junior) 35. Western Horsemanship (Intermediate) 36. Western Horsemanship (Senior) 38. Reining (Junior 3-7 grade) 39. Reining (Senior 8-12 grade) NOTES: Age Divisions based on their grade on September 1, 2018, not during the show!!! Class order will not be changed the day of the show. A DQ or 0 score means exhibitors do not advance to State. Exhibitors may bring questionable English and Western tack and equipment (example: bits) to the judge at orientation. Western equipment can be presented to the judge before the start of Western Pleasure.

7 SE DISTRICT 4-H HORSE SHOW MAP TO PONTOTOC COUNTY AGRI-PLEX 1700 N. Broadway Ada, OK

8 SE DISTRICT 4-H HORSE SHOW NOMINATION FORM FOR FLAG BEARER DUE DATE: April 30, 2019 TO THE DISTRICT OFFICE Instructions: Educators may nominate youth for flag bearer on the form below. A total of four youth will be chosen 2 for Monday, June 3 rd, and 2 for Tuesday, June 4 th. Due date to the District Office is April 30 th. Please submit one form for each nomination. Requirements for Presenting the American Flag on Horseback: Provide name, address, phone number and address of 4-H member being nominated. It is required that youth who are nominated for this honor be participating in the District Horse Show. Please specify which day Monday or Tuesday you are entering classes in the District Horse Show. Youth need to be at least 14 years old in order to be nominated. Educators need to make sure that youth are capable of handling the flag while riding. COUNTY NOMINATIONS FLAG BEARER NOMINEE (must be 14 or older): Name of 4-H member: Age: Address: City, State and Zip Code: Home Phone: Cell Phone: address of parent/guardian: address of nominee (4-H member): Entering District Horse Show Classes on Monday, June 3 Entering District Horse Show Classes on Tuesday, June 4

9 CHECKLIST Southeast District 4-H Horse Show REQUIRED Return To: SE District Office PO Box 1378 Ada, OK by April 30, 2019 ENTRY WILL NOT BE ACCEPTED UNTIL ALL OF THE FOLLOWING REQUIREMENTS ARE MET. EDUCATORS ARE TO CHECK OR INITIAL ALL AREAS IF THEY ARE COMPLETE. THANK YOU! Contestant s Name County 4-H Member is an ACTIVE member in 4-H Online before April 30, 2019 checked by Educator Signatures on SE District Horse Show Entry Form of: Contestant Parent or Guardian Fees for entries and/or stalls, RV s, extra t-shirts attached AND are correct! Policy Agreement/Release of Liability Form Signatures of: Contestant Parent or Guardian Horse Ownership and 4-H Membership Verification Form Signatures of: 4-H Member Parent or Guardian Extension Educator If any horses listed on Horse Ownership and 4-H membership Verification Form are leased, you must attach a lease agreement with the signature of both the 4-H contestant and the parent or guardian. Copy of negative Coggins for each horse entering show valid through June 4, 2019 and is legible. Completed Youth Participation Form (Form 1) with all signatures.

10 2019 SOUTHEAST DISTRICT 4-H HORSE SHOW ENTRY FORM Please type or print clearly: Name of 4-Her Birthdate (mm/dd/yyyy)grade in School (as of 9/1/18) Phone ( ) Address City Zip County Parent/Guardian address: Age Division determined on grade on September 1, 2018 : Return to: SE District Office PO Box 1378 Ada, OK by April 30, 2019 Junior 8 & 3 rd grade, 4 th, or 5 th grade Intermediate 6 th, 7 th, or 8 th grade Senior 9 th, 10 th, 11 th, or 12 th grade Each contestant may enter up to two horses. Those horses must be exhibited by that contestant only. A contestant may not enter the same class twice. Youth will be allowed to show two mares or two geldings in halter, as long as the horses are in different age classes. Class numbers and class fees must match. Be sure you have all classes you want to enter listed on this entry form. Please make sure you review the NEW substitution rule before entering!!! Horse A: Official Name of Horse Registration No. Age Circle One: MARE GELDING Breed Check Classes below for this horse to be entered. Please note that Western Pleasure/Ranch Riding cannot use the same horse and Trail/Ranch Trail cannot use the same horse. 1. Breakaway Roping (Junior grade) 2. Breakaway Roping (Senior grade) 3. Calf Roping (all ages) 4. Barrel Race (Junior) 5. Barrel Race (Intermediate) 6. Barrel Race (Senior) 7. Pole Bending (Junior) 8. Pole Bending (Intermediate) 9. Pole Bending (Senior) 10. Stakes (Junior) 11. Stakes (Intermediate) 12. Stakes (Senior) 13. Halter Mares -- 5 years and younger 14. Halter Mares 6 years and older 15. Halter Geldings 5 years and younger 16. Halter Geldings 6 years and older 17. Showmanship at Halter (Junior -- English & Western) 18. Showmanship at Halter (Intermediate English & Western) 19. Showmanship at Halter (Senior English & Western) 20. Hunter Under Saddle (Junior) 21. Hunter Under Saddle (Intermediate) 22. Hunter Under Saddle (Senior) 23. Hunt Seat Equitation (Junior) 24. Hunt Seat Equitation (Intermediate) 25. Hunt Seat Equitation (Senior) 26. Hunter Hack (Junior grade) 27. Hunter Hack (Senior grade) 28. Trail (Junior) 29. Trail (Intermediate) 30. Trail (Senior) 31. Western Pleasure (Junior) 32. Western Pleasure (Intermediate) 33. Western Pleasure (Senior) 34. Western Horsemanship (Junior) 35. Western Horsemanship (Intermediate) 36. Western Horsemanship (Senior) 37. Western Riding (all ages) 38. Reining (Junior grade) 39. Reining (Senior grade) 40. Ranch Riding (Junior grade) 41. Ranch Riding (Senior grade) 42. Ranch Horse Trail (Junior grade) 43. Ranch Horse Trail (Senior grade) 44. Ranch Roping (Junior grade) 45. Ranch Roping (Senior grade) 46. Working Cow Horse/Boxing Only (Junior grade) 47. Working Cow Horse/Boxing Only (Senior grade) Horse B: Official Name of Horse Registration No. Age Circle One: MARE GELDING Breed Check Classes below for this horse to be entered. Please note that Western Pleasure/Ranch Riding cannot use the same horse and Trail/Ranch Trail cannot use the same horse. 1. Breakaway Roping (Junior grade) 2. Breakaway Roping (Senior grade) 3. Calf Roping (all ages) 4. Barrel Race (Junior) 5. Barrel Race (Intermediate) 6. Barrel Race (Senior) 7. Pole Bending (Junior) 8. Pole Bending (Intermediate) 9. Pole Bending (Senior) 10. Stakes (Junior) 11. Stakes (Intermediate) 12. Stakes (Senior) 13. Halter Mares -- 5 years and younger 14. Halter Mares 6 years and older 15. Halter Geldings 5 years and younger 16. Halter Geldings 6 years and older 17. Showmanship at Halter (Junior -- English & Western) 18. Showmanship at Halter (Intermediate English & Western) 19. Showmanship at Halter (Senior English & Western) 20. Hunter Under Saddle (Junior) 21. Hunter Under Saddle (Intermediate) 22. Hunter Under Saddle (Senior) 23. Hunt Seat Equitation (Junior) 24. Hunt Seat Equitation (Intermediate) 25. Hunt Seat Equitation (Senior) 26. Hunter Hack (Junior grade) 27. Hunter Hack (Senior grade) 28. Trail (Junior) 29. Trail (Intermediate) 30. Trail (Senior) 31. Western Pleasure (Junior) 32. Western Pleasure (Intermediate) 33. Western Pleasure (Senior) 34. Western Horsemanship (Junior) 35. Western Horsemanship (Intermediate) 36. Western Horsemanship (Senior) 37. Western Riding (all ages) 38. Reining (Junior grade) 39. Reining (Senior grade) 40. Ranch Riding (Junior grade) 41. Ranch Riding (Senior grade) 42. Ranch Horse Trail (Junior grade) 43. Ranch Horse Trail (Senior grade) 44. Ranch Roping (Junior grade) 45. Ranch Roping (Senior grade) 46. Working Cow Horse/Boxing Only (Junior grade) 47. Working Cow Horse/Boxing Only (Senior grade)

11 HORSE SHOW PARTICIPANT S SHIRT SIZE (Youth Small-Adult 3XL) T-SHIRT ORDER FORM FREE ADDITIONAL T-SHIRT ORDERS SIZE QUANTITY COST -- # OF SHIRTS Youth Small -- $15 Youth Medium -- $15 Youth Large -- $15 Adult Small-- $15 Adult Medium-- $15 Adult Large -- $15 Adult XLarge -- $15 Adult XXLarge -- $15 Adult XXXLarge -- $15 Total Shirt Fee HORSE SHOW ENTRY FEES GENERAL ENTRY FEES: (All Exhibitors pay general fee.) $ CLASS FEES: # Classes X $ 5.00 = STALLS: Sunday Stall Fee -- # Stalls X $20.00 = Monday Stall Fee -- # Stalls X $20.00 = Tuesday Stall Fee -- # Stalls X $20.00 = 3 DAY DISCOUNT RATE: SUN/MON/TUES STALL FEE -- # Stalls X $50.00 RV RENTAL: Sunday RV Fee -- # RV Spaces X $25.00 = Monday RV Fee -- # RV Spaces X $25.00 = Tuesday RV Fee -- # RV Spaces X $25.00 = LATE FEE: $ if received or postmarked May 1 st through May 20 th EXTRA T-SHIRT ORDER FEE (complete order in box above) TOTAL REGISTRATION FEES $ Make Checks payable to OSU Southeast District Extension Office. We, and (Parent or Guardian Signature) (Contestant Signature) agree that the management of the Southeast District 4-H Horse Show facilities, Management Committee, and the Southeast District 4-H Horse Show Committee will not be held liable for any lost or damaged property or injury to horse or contestant at or during the 2019 District Horse Show. Furthermore, we have read and understand the rules and regulations for Oklahoma 4-H Horse Shows and the Southeast District 4-H Horse Show Supplement, and will follow the rules of the show.

12 2019 SOUTHEAST DISTRICT 4-H HORSE SHOW POLICY AGREEMENT 1. Requests for refunds will not be processed after the late entry fee date of May 20. Request for refunds between May 20 th and the show date must be received in writing before the start of the Show and must be accompanied by a doctor s or veterinarian s statement indicating medical or veterinary reason. 2. A fee of $50.00 will be charged for substitution of a horse, regardless of whether the substitution is prior to the show or at the show. 3. No one other than the contestant is allowed to ride their project horse while at the District 4-H Horse Show. 4. Horses are to be ridden only in designated riding areas (arenas, warm up areas). 5. All contestants are to be accompanied by a parent, guardian, or other responsible adult while on the show grounds. If someone other than the parent or guardian is to be the responsible adult accompanying the contestant on the show grounds, the parent or guardian must list that person on the following blank AND they MUST complete and sign a medical release form. Name of Responsible Adult accompanying youth (if different from the parent or guardian indicated below) 6. Safe practices to protect you, other riders, spectators and show officials will be followed. To be eligible to participate, rules and policies as outlined in the 2019 Oklahoma State 4-H Horse Show Rule Book regarding show participation, safety, sportsmanship and class requirements will be followed. RELEASE OF LIABILITY This Consent and Release executed by (contestant) and (parent/guardian), on behalf of said minor child as his/her parent or legal guardian and is executed for the purpose of allowing said child to participate in the Southeast District 4-H Horse Show sponsored by the Southeast District OSU Extension Office on June 2-4, The undersigned are aware that this horse riding activity carries certain risks as a horse is a strong and powerful animal capable of great speed and quick reactions. In further consideration of the Southeast District OSU Extension Office allowing the child to participate, I hereby agree as the above named child s parent or guardian to pay for, defend, indemnify and hold the Southeast District OSU Extension Office, Carter County, Hardy Murphy Coliseum, and all their agents, employees, successors and assigns harmless from any and all liabilities, claims and demands for loss, damage, or injuries to the above named child or his/her property. By signing, the contestant and parent or guardian indicate they have read and agree to the Policy Agreement and Release of Liability. Dated this day of, 2019 Contestant s Signature Parent or Guardian Signature 7klahoma State University, U.S. Department of Agriculture, State and Local governments cooperating. Oklahoma State University, in compliance with Titles VI and VII of the Civil Rights Act of 1964, Executive Order as amended, Title IX of the Education Amendments of 1972, Americans with Disabilities Act of 1990, and other federal and state laws and regulations, does not discriminate on the basis of race, color, national origin, gender, age religion, disability, or status as a veteran in any of its policies, practices, or procedures.

13 Horse Ownership and 4-H Membership Verification Form Exhibitor s Name Home Address, City, State Zip Code County Name of 4-H Club ALL information must be completed! Please list up to four horses below. One or two horses may be entered in the District Horse Show and others may be listed in the event a substitution is needed due to injury. If any horses listed below are leased, you must attach a copy of the lease agreement with the signature of the 4-H member and parent or guardian. A) B) C) D) Horses Name* Sex Breed Age Registration # Owner / Relationship to Rider * Please use Horse s Registered Name when applicable We hereby certify that the above named animal(s) is owned by the above named exhibitor; or their brother, sister, parent or legal guardian on this date and ownership will be retained through the District and State 4-H Horse Show at which the horse may be shown. We have read and will comply with the general Rules and Regulations and Code of Ethics governing Oklahoma 4-H Horse Shows, which includes but are not limited to the following: 1) Any surgical procedure or injection of any foreign substance or drug, which could affect the horse's performance or alter its natural conformation or appearance is prohibited, except for those surgical procedures performed by a duly licensed veterinarian for the sole purpose of protecting the health of the horse. 2) Establish the animal's welfare as a major priority and insure that all actions, including training, transporting, stalling, grooming, and showing, reflect that goal at all times. Signature of 4-H Member Date Signature of Parent or Guardian Signature of Extension Educator Date Each exhibitor must complete and return this form with the District Horse Show Entry Form. Entries will NOT be accepted without the Horse Ownership and Membership Verification Form!!!! 7klahoma State University, U.S. Department of Agriculture, State and Local governments cooperating. Oklahoma State University, in compliance with Titles VI and VII of the Civil Rights Act of 1964, Executive Order as amended, Title IX of the Education Amendments of 1972, Americans with Disabilities Act of 1990, and other federal and state laws and regulations, does not discriminate on the basis of race, color, national origin, gender, age religion, disability, or status as a veteran in any of its policies, practices, or procedures.

14 HORSE LEASE AGREEMENT Oklahoma 4-H Youth Development I/We, (owner) and (lessee) do hereby enter into a lease agreement for the horse named, APHA Registration # on this date for a period of months. The lessee will be responsible for all care, fed, board, veterinarian fees, and any other expenses that occur while this lease is in effect. The owner will not be held responsible for any and all liabilities, claims and demands for loss, damage, or injuries to the lessee during the terms of this agreement. If any injury or death to the horse occurs during this time, it is the responsibility of the lessee to reimburse above named owner the fair market value of the horse. Transportation of the above named horse will be by owner only. By signing this agreement the owner and lessee indicate that they have read, understand, and agree with said lease. Dated this day of, 2019 Lessee Signature Lessee Signature Owner- Signature Owner- Signature Revised 2018 Page 1 of 6

15 Oklahoma 4-H Youth Development Youth Participation Form PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. THIS IS A LEGALLY BINDING DOCUMENT. THIS SIGNED FORM MUST BE SUBMITTED BY A PARENT/LEGAL GUARDIAN BEFORE ANY CHILD IS ALLOWED TO PARTICIPATE IN THE REFERENCED PROGRAM/CAMP/TRIP/EVENT SPONSORED BY 4-H. Form 1 Today s Date: County Program/Camp/Trip/Event: PARTICIPANT INFORMATION Overnight Event YES NO Name of Participant: Address: City: State: Zip: Date Of Birth: Gender: M F MEDICAL INFORMATION - Oklahoma State University requests the information below so that in case of emergency, we have accurate information to provide and/or seek appropriate treatment for Participant. You are accountable for providing an accurate medical history. If Participant has any medical issue that is not requested below, but which you think is important, please include that information. If you are uncertain about any pre-existing medical conditions, it is your responsibility to consult with your own physician prior to participating in this Program. As a participant, parent, or guardian it is your responsibility to disclose relevant information that may result in harm to Participant and/or others during this Program. By revealing or disclosing the medical information in this document it will not be used by Oklahoma State University personnel or employees to determine Participant s ability to participate safely in activities. I understand that, if Participant chooses to participate in activities, he/she does so voluntarily and of his/her own accord and the final decision regarding participation is solely the responsibility of myself and Participant. Final determination about whether to participate is the responsibility of you and your physician. This information will be kept in strict confidence and will only be shared with your permission. In cases where medical attention is necessary, parents will be contacted for approval when possible; however, in the event of an emergency the 4-H staff will seek medical care for any child in their care. Oklahoma State University does not offer any form of insurance for participant while participating in Programs. Full medical expense will be the responsibility of parent or guardian. By signing this form, I represent and warrant that I have provided all materials and important information to Oklahoma State University pertaining to my Participant s medical, mental and physical condition and that it is accurate and complete. I agree to notify the 4-H program and or Oklahoma State University of any changes in the mental, physical or medical condition of the Participant prior to any scheduled Program. Signature of Parent/Guardian Today s Date INSURANCE INFORMATON Do you have health/accident insurance? (circle one): YES NO Insurance Company Name: PARENT/GUARDIAN INFORMATION Parent/Legal Guardian Name: Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: EMERGENCY CONTACT INFORMATION #1 Name Relationship Phone: #2 Name Relationship Phone: Revised 2018 Page 2 of 6

16 Oklahoma 4-H Youth Development Medications being taken? If any prescription Types of Medications being medications are being taken, page 3 must be complete taken as the parent/guardian is legally responsible for the Prescription medications and the self- administered of the Over the Counter prescription by the participant. Check ALL Allergies/Reactions History of Allergies or Medication Insects/stings/bites reactions to: Plants Other List Medications: Explain Allergies/Reactions: History of Food Allergies? Eggs Dairy Fish/Shellfish Check ALL Allergies Nuts Wheat Other Explain Food Allergies: Dietary Restrictions or special needs? Explain Dietary Needs: Physical, behavioral or Check ALL that apply mental health condition ADD/HDHD Epilepsy/Convulsions that would limit Asthma Heart/Lung participation in normal Autism/Asperser s Nose Bleeds activities/projects? Diabetes Other Do any of the following Check ALL that apply Medical Assistance apply? Dentures/Dental Prosthetic Plate/Partial/Retainer Wheelchair/Walker/Cane/Cru Glasses/Contact Lenses tches Hearing Aid/Implant Other Explain Condition/Limitation(s): Other: (Explain) AUTHORIZATION FOR OVER-THE-COUNTER MEDICATION Generally, 4-H staff will only have minor first aid supplies at overnight events and will avoid dispensing medications; however, at times a child may become ill and unless we have parental authorization, we cannot administer ANY medications. Below is a list of common OTC medication. By checking a box below, I authorize that the following medications may be given to Participant if the need arises. I shall indemnify and hold harmless the Program Staff, Oklahoma State University, its Board of e g e n ts, Administration, Faculty, Staff, Student Leaders, Volunteers and all o the r officers, directors, employees and agents against any claims that may arise relating to my child being administered the below indicated over- the-counter medications. R If Box 1 or 2 is checked, box 3 does not have to be completed. BOX 1 BOX 2 Parent/guardian APPROVAL REQUIRED before using any over-the-counter edication. ANY over-the-counter MEDICATION LISTED CAN BE USED without parent/guardian approval. BOX 3 Program Staff/Extension Educator/Certified Adult 4-H Volunteer/Medical Professional MAY ADMINISTER ONLY THE FOLLOWING OVER-THE-COUNTER PRODUCTS when the need arises. Sunscreen Bug repellent Ointments for minor wound care or first aid as directed. (Antiseptic, antiitch, anti-sting, antibiotic, sunburn) Tylenol/Acetaminophenas directed. Ibuprofen as directed. Throat lozenges and or spray as directed for sore throat. Hydrocortisone ointment as directed for mild skin irritations, poison ivy, and insect bites. Medicated powder for skin irritation as directed. Calamine lotion for bug bites and poison ivy. Medicated lip ointment for dry, chapped lips, lip blisters or canker sores as directed. Kaopectate or Imodium for diarrhea as directed. Milk of Magnesia, Pepto-Bismol or Mylanta for upset stomach or nausea as directed. Rolaids or Tums for acid reflux, heartburn or indigestion as directed. Benadryl for swelling, hives, allergic reaction, as directed. Actifed or Sudafed as directed for nasal congestion or allergy relief per instructions. Visine or other eye drops for minor eye irritation. Swimmer s ear drops as directed. Robitussin or other cough syrup as directed. Other (list any other approved over-the counter medication) Revised 2018 Page 3 of 6

17 Oklahoma 4-H Youth Development Authorization, Waiver and Consent for Self-Administration of Prescription Medications This page must be completed in full in order for Participant to self-administer required prescription medications. Prescription Medication(s) information must be UPDATED prior to any Program/Activity/Event requiring a medical information form to participate. Each prescription medication, dosage and time of administration must be noted. Self-medication of any narcotic requires a licensed health care signature on this form. All prescription medications, including medications for conditions such as food, drug or insect allergies; diabetes; asthma or epilepsy may be brought to the 4-H event, program, or trip under the condition that the participant has written authorization to self-manage their care and the consumption/administration of medication. Prescription medication must be in its original container labeled by the pharmacist and prescriber. Label must include the name, address and phone number for pharmacist and prescriber s name. Containers must hold only the amount required for the time the participant will be attending the 4-H event. I (Print full Name of Parent/Guardian) have legal authority to consent to medical treatment, including the administration of Rx medication for this minor. Today s Date I accept the responsibility to keep the prescription information current while my child is enrolled in 4-H. Parent/Guardian Initials I authorize and recommend self-medication by my child for the medications listed on this form. Parent/Guardian Initials I also affirm that he/she has been instructed in the proper self-administration of the prescribed medication by his/her attending physician. Parent/Guardian Initials I shall indemnify and hold harmless the Program Staff, Oklahoma State University, its Board of Regents, Administration, Faculty, Staff, Student Leaders, Volunteers and all other officers, directors, employees and agents against any claims that may arise relating to my child s self-administration of prescribed medication(s). Parent/Guardian Initials PRESCRIBER AUTHORIZATION FOR SELF-ADMINISTRATIONOF PRESCRIPTION MEDICATION Medication Name: Dose Conditionfor which medication is being administered: SpecificDirections (e.g., on empty stomach/with water, etc.): Time/frequencyof administration: IfPRN (as needed), frequency: Relevantside effects: Medicationshall be administered from (date) SpecialStorage Requirements: IfPRN, for what symptoms: to Isthe participant capable of self-managed care? YES NO Prescriber s Name/Title: Prescriber s Place of Employment: Telephone: Fax: Ihereby affirm that this individual has been instructed in the proper self-administration of the prescribed narcotic. Prescriber s Signature necessary only if the medication is a narcotic: Date: LIST ADDITIONAL PRESCRIPTION MEDICATIONS ON THE NEXT PAGE Revised 2018 Page 4 of 6

18 Oklahoma 4-H Youth Development PRESCRIBER AUTHORIZATION FOR OF PRESCRIPTION MEDICATION Medication Name: Dose for which medication is being Directions (e.g., on empty stomach/with water, of PRN (as needed), PRN, for what side shall be administered from (date) Storage the participant capable of self-managed care? YES NO Prescriber s Name/Title: Prescriber s Place of hereby affirm that this individual has been instructed in the proper self-administration of the prescribed narcotics. PRESCRIBER AUTHORIZATION FOR OF PRESCRIPTION MEDICATION Medication Name: Dose for which medication is being Directions (e.g., on empty stomach/with water, of PRN (as needed), PRN, for what side shall be administered from (date) Storage the participant capable of self-managed care? YES NO Prescriber s Name/Title: Prescriber s Place of hereby affirm that this individual has been instructed in the proper self-administration of the prescribed narcotics. PRESCRIBER AUTHORIZATION FOR OF PRESCRIPTION MEDICATION Medication Name: Dose for which medication is being Directions (e.g., on empty stomach/with water, of PRN (as needed), PRN, for what side shall be administered from (date) Storage the participant capable of self-managed care? YES NO Prescriber s Name/Title: Prescriber s Place of hereby affirm that this individual has been instructed in the proper self-administration of the prescribed narcotics. Revised 2018 Page 5 of 6

19 Oklahoma 4-H Youth Development These guidelines are not all inclusive, the Extension Service reserves the right to make Rules Participants and Parents Need to Know: I. In seeking uniformity in the conduct expected at each county, district, state, national, and international 4-H event, the following guidelines have been developed. Each participant has a reasonable expectation to enjoy a positive program experience. Therefore, the misbehavior of one participant, or a group of participants, will not be permitted to negatively impact the program experience of others. Most programs are short in duration, so prompt action is required when problems occur. All rules and regulations governing an activity, event or facility use will be discussed with educators, certified volunteers, parents and 4-H'ers prior to or at the beginning of each event. All 4-H'ers are under the supervision of any Extension staff or certified volunteer(s) assigned to the event. If the 4-H'er is found in violation of the Code of Conduct and disciplinary action is required his/her parent/guardian will be notified immediately and the 4-H'er may be suspended from participation in county, district, state, national and international 4-H activities and/or membership revoked. As deemed necessary, the appropriate County, District or State 4-H Office will be notified of disciplinary action. Participants dismissed from a program for disciplinary reasons will not receive a refund on any fees paid to attend. If a 4-H'er wishes to appeal the disciplinary action he/she must appeal in writing through their County Extension Office. Appeals must be filed within 30 days following notification of punishment. As necessary, the State 4-H Leader shall appoint an appeal board, no sooner than 30 days following the date of notification of the disciplinary action. Participants are responsible for securing their belongings. Neither Oklahoma State University, nor Ext. Staff or certified volunteer, is responsible for lost or stolen items. Leave excess money and valuables at home. Valuables brought to the program are at participants risk and can only be used at free or other authorized times. II. CODE OF CONDUCT - Rules and Disciplinary Procedures The following actions will be considered a serious breach in conduct. This is not an all-inclusive list of conduct violations. Misconduct is deemed in violation of a law - The exceptions to this policy. However, in every case, appropriate law enforcement agency will be notified. permission for exceptions must be secured from Assault or Personal Harm Inflicting physical or emotional chaperone in advance. harm on self or others. Theft, Misuse or Abuse of Public or Personal Property - Any Bullying and Harassment Physical, emotional or damages caused by neglect or misuse will be charged to the electronic harassment/harm against self, fellow responsible party. Replacement cost will be charged to participants or staff. anyone who removes or damages property. Any individual found tampering with any fire equipment (i.e. fire Possession, distribution, sale or use of illegal extinguishers, fire alarms, smoke detectors, etc.) will be drugs/substances, alcoholic beverages; any form of dismissed from the Program immediately. Participants may tobacco or vapor products, fireworks; and/or weapons not interfere with any security system or tamper with locks in (does not limit the use of approved sporting arms when and participant rooms and other areas. All furniture must remain where authorized). unchanged and kept in place. Sexual Misconduct Engaging in contact of a sexual Search of Property - If a question regarding any of the nature. above is raised, 4-H member consents to a search of Coed Visitation Coed visitation is permitted only in his/her room and/or personal property. Failure to comply designated common areas not in sleeping rooms. It is will result in violation of the Code of Conduct. recognized that circumstances may arise for justifiable III. The following actions will be considered a breach in conduct. This is not an all-inclusive list of conduct violations. Breaking curfew and/or disturbing the peace - Use of Abusive and Offensive Language Participants will abide by curfew. Vandalism and Pranks Violating the Dress Code Unexcused Absence from the activities of the event - Participants are to remain on the event site and attend all workshops, classes, and planned social or recreational activities for the duration of the program unless program activities require otherwise. If a participant needs to leave campus or event site, supervising ext. staff or certified volunteer must have prior written approval from the parent or guardian, and agree to grant specific permission. Unauthorized use of Vehicles during the event - Participants are not allowed to drive or ride in personal vehicles during the dates of the program unless they receive specific permission to do so from their supervising extension staff or certified volunteer. While we understand that some participants will drive to the event, our policy is that participants should not be driving during the event. Participants may be asked to turn their car keys in to the supervising staff or certified volunteer for the duration of the program. Misuse of Technology - Participants must never misuse internet, social media, cell phone or any new technological devices. Accessing or sending unauthorized or inappropriate content is strictly prohibited. Revised 2018 Page 6 of 6

20 Informed Consent, Voluntary Waiver, Release of Liability & Assumption of Risks I, the undersigned, wish for my Child (hereafter Child ) to participate in the above referenced youth program (hereafter Program ) on the date(s) and location(s) indicated above and, in consideration for my Child s participation, I hereby agree as follows: I acknowledge, understand and appreciate that as part of my Child s participation in the Program there are dangers, hazards and inherent risks to which my Child may be exposed, including the risk of serious physical injury, temporary or permanent disability, and death, as well as economic and property loss. I further realize that participating in the youth program may involve risks and dangers, both known and unknown, and have elected to allow my Child to take part in the Program. Therefore, I, on behalf of my Child, voluntarily accept and assume all risk of injury, loss of life or damage to property arising out of training, preparing, participating, and traveling to or from the Program. I, on behalf of my Child, hereby release Oklahoma 4-H, Oklahoma State University, its Board of Regents, Administration, Faculty, Staff, Student Leaders, the Program Staff, and all other officers, directors, employees, volunteers and agents (hereafter OSU ) from any and all liability as to any right of action that may accrue to my heirs or representatives for any injury to my Child or loss that my Child may suffer while training, preparing, participating and/or traveling to or from the above indicted event. This agreement is binding on my heirs and assigns. In the event of an accident or serious illness, I hereby authorize representatives of OSU to obtain medical treatment for my Child on my behalf. I hereby hold harmless and agree to indemnify OSU from any claims, causes of action, damages and/or liabilities, arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my Child that may occur during his/her participation in the Program. This RELEASE shall be governed by and construed under the laws of Oklahoma. I agree that any legal action or proceeding relating to this RELEASE, or arising out of any injury, death, damage or loss as a result of my Child s participation in any part of the Program, shall be brought only in Payne County, Oklahoma. This RELEASE contains the entire agreement between the parties to this agreement and the terms of this RELEASE are contractual and are not all inclusive. The information I have provided is disclosed accurately and truthfully. I have been given ample opportunity to read this document and I understand and agree to all of its terms and conditions. I understand that I am giving up substantial rights (including my right to sue), and acknowledge that I am signing this document freely and voluntarily, and intend by my signature to provide a complete and unconditional release of all liability to the greatest extent allowed by law. My signature on this document is intended to bind not only myself and my Child but also the successors, heirs, representatives, administrators, and assigns of myself and my Child. I have read and discussed this document in its entirety. Participant Name Parent/Guardian Name Participant Signature Parent/Guardian Signature Date Date A PARENT OR GUARDIAN MUST SIGN THIS FORM FOR A MINOR UNDER THE AGE OF 18 7klahoma State University, U.S. Department of Agriculture, State and Local governments cooperating. Oklahoma State University, in compliance with Titles VI and VII of the Civil Rights Act of 1964, Executive Order as amended, Title IX of the Education Amendments of 1972, Americans with Disabilities Act of 1990, and other federal and state laws and regulations, does not discriminate on the basis of race, color, national origin, gender, age religion, disability, or status as a veteran in any of its policies, practices, or procedures.