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1 Oklahoma Cooperative Extension Service Northwest District 205 W. Maple Ave., Suite 510 Enid, Oklahoma Phone: Fax: YOU WILL ONLY RECEIVE THIS BY TO: FROM: N.W. District Extension Educators Jim Rhodes N.W. District 4-H Youth Development Program Specialist DATE: February 12, 2015 RE: NORTHWEST DISTRICT 4-H HORSE SHOW & RANCH HORSE SHOW June 9 & 10, :45 A.M. Alfalfa County Fairgrounds, West 5 th Street, Cherokee, Oklahoma Attached is a packet you may send to your 4-Hers who are interested in participating at the NW District 4-H Horse Show and the Ranch Horse Show. Entry information and all forms will also be available on the N.W. District website: Horse ownership and 4-H membership date to be eligible to participate in the 2015 NW District 4-H Horse Shows is May 1, All applicable forms and checks must be attached to the entry form. An Educator s signature is required but does not have to be notarized. All documents are due in the County Extension Office on May 1, All forms are due to the NW District Office by 5:00 p.m. on May 4, Ranch Horse Rules are incorporated into the State Horse Show Rule Book available here: Please discard all previous dated books, Horse certification forms and entry forms. Please check that youth are enrolled in 4-H by May 1, 2015 and refer to the 2015 Publication #103 for all other age requirements. The exhibitor s and parent or guardian s notarized signatures are required certifying proper ownership and husbandry along with the Policy Agreement/Release of Liability Form. Incomplete or late forms will not be accepted. Sponsorship for the 2015 NW District 4-H Horse Shows The NW District 4-H Horse Council Board wants to extend the invitation to 4-H Horse Clubs, businesses or individuals in the district to make a donation to the show. We anticipate entries will be up in Sponsorship helps us to break even without increasing entry fees at this time. Sponsorships help defray costs for class awards, highpoints, reserves and judges. A donor letter is attached that you may use if needed. We would appreciate your help in carrying out the show and can use parents/volunteers to assist at the show. There is a place on the entry form that they can indicate times they are available. Please call if you have questions. Enclosures: Letter for 4-H Members Volunteer Request Form Horse Certification Form Donor Letter Horse Show Entry Form Horse Show Check Sheet Ranch Horse Entry Form Policy Agreement/Release of Liability Form RAM Form/Code of Conduct cc Kris Hiney Rusty Gosz N.W. District Administrative Support Staff Revised 2/12/2015 Oklahoma State University, U. S. Department of Agriculture, State and Local governments cooperating. Oklahoma State University in compliance with Title 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.

2 Oklahoma Cooperative Extension Service Northwest District 205 W. Maple Ave., Suite 510 Enid, Oklahoma Phone: Fax: TO: 4-H Youth with Horse Projects FROM: Jim Rhodes N.W. District 4-H Youth Development Program Specialist DATE: February 12, 2015 RE: NORTHWEST DISTRICT 4-H HORSE SHOW & RANCH HORSE SHOW June 9 & 10, :45 A.M. Alfalfa County Fairgrounds, Cherokee, OK, West 5 th Street PROCEDURE FOR ENTRY In 2015, as a part of the entry a Policy Agreement/Release of Liability form (enclosed) is required. It outlines the inherent risks of working around horses. The contestant and parent/guardian are acknowledging that they have the skills necessary to safely participate. A Horse Certification Form is also required. The exhibitor and a parent or guardian must sign certifying that they meet ownership requirements and will comply with the general rules and regulations and code of ethics governing Oklahoma 4-H Horse Shows. Their signatures must be notarized on both forms. Your Extension Educator s signature is required on the certification form. They are signing only that the 4-H member is enrolled and meets age and eligibility requirements. Many counties request certification forms in their office prior to entries being sent out. They are then attached when entries are mailed in from the county office or requested from the district office. Please list on the certification form all horses that this specific 4-Her may choose to use at the district shows including horses they may substitute in case of injury to a horse they intend to show. Substitutions for horses listed on entry form will require a letter from a veterinarian. If a horse is not listed on that specific youth s certification form, they cannot substitute that horse. ENTRY AND HORSE CERTIFICATION FORMS...All forms must be accurately completed and in the County Office on May 1, 2015 and due to the N.W. District 4-H Office, 205 W. Maple, Suite 510, Enid, OK no later than 5:00 p.m. on MAY 4, (NOTE: Some forms require Extension Educator s Signature.) A check for the appropriate amount must accompany entry form. Please make it payable to the N.W. District 4-H Programs. INCOMPLETE OR LATE ENTRIES WILL NOT BE ACCEPTED. Please strive for accuracy as you complete the form and enclose the proper amount for entry fees. Oklahoma State University, U. S. Department of Agriculture, State and Local governments cooperating. Oklahoma State University in compliance with Title 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.

3 RULES AND REGULATIONS...The 2015 State and District 4-H Horse Show Rules (4-H ANSI 402) will govern the District 4-H Horse Show. The AQHA rule book will be used as a backup with a majority vote of board members available at the show being the final authority. The Ranch Horse Show rules are incorporated in the state Horse Show Rulebook online here: 1. Membership and Age requirements: Youth must meet requirements and be enrolled as a member of Oklahoma 4-H (refer to the current year s State 4-H Publication 103 A Message for 4-H Families 4-H Membership Policy). Refer to the membership policy publication for details on membership requirements not stated within the following category explanations. Age categories between 9-11, and are divided on age as of January 1st of the competition year. The following age categories will be used at the district and state qualification shows. Ages 9-11: Must be an Oklahoma 4-H member that is 1) a minimum of 9 years of age at time district entry is due 2) a member at least 30 days before showing at the district show, and 3) no older than 11 years of age as of January 1 of the competition year. Ages 12-14: Must be an Oklahoma 4-H member that is 1) a member at least 30 days before showing at the district show and at time district entry is due, 2) at least 12 years of age and no older than 14 years of age as of January 1 of the competition year. Ages 15-19: Must be an Oklahoma 4-H member that is 1) a member at least 30 days before showing at the district show and at time district entry is due, and 2) at least 15 years of age by January 1 of the competition year and have not reached the age of 19 years on or before January 1 of the of the calendar year of competition. An exception is noted that youth who reach or pass their 19th birthday by December 31 (of the prior calendar year) while still in high school; They may remain in 4-H for the remainder of that school year and may exhibit at that calendar year s State and District 4-H Horse Shows. 3. The number of state show qualifiers will be based on the number in the class for that specific event. It will range from 10 to 14 per class (see rule book for chart). 4. A 4-H member may enter up to two horses in the District Horse Shows. Those two horses must be shown and/or ridden by that contestant only. A contestant or a horse cannot enter the same class twice. An entry in the 2 year old training class can be a third horse. All horses that might be used have to be on the horse certification form. If not on that form, it cannot be substituted. 5. All champion High Point awards will be accumulated on a one horse-one rider basis. Points accumulated on different horses cannot be combined. Points accumulated in halter placings will not count toward the Performance Champion High Point Awards. (See rulebook for additional details.) We will conduct the Horse Shows with one arena and one judge. We will follow the show order for each age division as listed. The Trail Class may be set up in a separate area, if so trail will be ran from 10 a.m. to 3 p.m. for all who have entered to participate as their schedule allows within the time allotted. Trail classes may be moved indoors if inclimate weather warrants the move. The show will be held as scheduled unless the weather creates hazardous conditions for riders and horses. No alternate dates are available.

4 AWARDS There will be Senior, Intermediate, and Junior Awards in each of the three divisions, English, Western Judged, and Western Timed. County High Point/Participation Awards High Point County Award will be determined by the total number of points received by 4-H members of a respective county. High Participation County determined by the total number of individuals entered from a respective county. STATE 4-H HORSE SHOW If you plan on participating at the 2015 State 4-H Horse Show you will have to fill out all the appropriate forms and pay your entry fee for eligible classes before you leave the District Horse Show. CLASSES 2 Year Old Class. If you have nominated a horse for the State 2 Year Old Horse Training Project Class, you do not have to qualify your futurity horse at the District Show. We will hold this class. If this is a third horse, use C on the entry form and provide the horse information on a separate sheet of paper. Trail Classes will consist of six or more obstacles, which will test horsemanship abilities. You must complete this class between 10 a.m. and 3 p.m. Optional trail obstacles that can be used are: Log drag (15-19 age group only) Horse must be willing to drag a log for a short distance, either in a straight line or around a set pattern. Rope should be dallied around the saddle horn and not tied hard and fast. Stationary steer (12-14 and age groups only). Horse to stand quietly while the rider makes a swing(s) and throw (rope) at the stationary steer. Missing the steer will not be penalized. Only one showmanship class will be held for each youth age division. English or Western attire can be worn. They will be judged against each other. Attire in the class will determine which division points will be included in for High Point. Mark entry on the specific line of entry form of which attire will be worn. Individual Classes may be canceled or combined if there are not an adequate number of entries. All those entering in canceled classes will automatically be eligible to enter the state show and class entry fees will not be refunded. Attached is a schedule of classes. If more than one horse is to be entered in the show, complete the information under horse A for the first horse and complete the information under horse B for the second horse. Then indicate either horse A or B in the blank before each class on the entry form entered indicating which horse is to be used in which class. List alternate horses only on Horse Certification form.

5 A NEGATIVE COGGINS CERTIFICATE is required (dated within 12 months of the District Show) and will be checked upon arrival at the show. Any horse not accompanied by a current negative Coggins Certificate will not be allowed to show or be kept on the show grounds. OVERNIGHT STALLS will be available on the grounds. It is preferred that you make arrangements in advance. For information about stalls contact Tommy Puffinbarger at Stall fees for the District show are $15.00 per night. The stall Barn is covered. Chips are available on site. R.V. HOOKUPS R.V. Hookups are available near the arena for $15.00 per night. Contact Tommy Puffinbarger, HOTEL/MOTEL ACCOMMODATIONS Cherokee has one motel; the Cherokee Inn is located within one mile of the Fairgrounds. Contact number is Other motels are located in Alva, Oklahoma, approximately 25 minutes away. VOLUNTEERS & PARENTS NEEDED Please complete the enclosed volunteer form if you would be willing to help at some time throughout the show. For individuals with disabilities who require auxiliary aids or services for program participation, please provide a detailed description of needs at the earliest possible date, but not later than May 1, If not requested in advance, it may not be possible to provide some aids and services. Reasonable effort will be made to accommodate individuals who request auxiliary aids or services. All entry fees and forms are due in the County Extension Office by Friday, May 1, 2015 and due in the N.W. District 4-H Office by noon on Monday May 4, We look forward to seeing you in Cherokee at the 2015 NW District 4-H Horse Show. Enclosures: Horse Certification Form Horse & Ranch Show Entry Forms Policy Agreement/Release of Liability Form Volunteer Request Form Donor Letter Show Check Sheets Map cc Kris Hiney Rusty Gosz Revised 02/12/2015

6 N.W. DISTRICT 4-H HORSE SHOW & RANCH HORSE SHOW 4-H HORSE CERTIFICATION FORM Exhibitor s Name: Date of Birth: Month/Day/Year Home Address: County of 4-H Membership: Street/RR City State Zip Name of 4-H Club: Please list all horses that you plan to use or would be used in case of injury to horse you intend to show. PLEASE MARK THROUGH ALL BLANKS BELOW (A D) THAT ARE NOT FILLED. A) B) C) D) Horse s Name Sex Breed Age Registration # If applicable Owner The undersigned hereby certify that the above named animal(s) is fully owned or leased (attach lease) by the above named exhibitor; or their brother, sister, parent, grandparent or legal guardian by May 1st and ownership will be retained through the District and State 4-H Horse Show at which the horse may be shown. Lease agreements should emphasize the same responsibilities as ownership regarding youth involvement with preparation and care of project horse/s. The parent or guardian signing is assuming the risk that their child and individual(s) attending the show with them are attending, working around and riding at their own risk. They are also acknowledging that they process the appropriate knowledge and skills to handle, ride, and work around horses and equine equipment. The undersigned are aware that this horse activity carries certain risks as a horse is a strong and powerful animal capable of great speed and quick reactions. They will not allow other individuals or animals who may or may not be familiar with horses to handle or be in a close area that may endanger participants, spectators, staff persons or animals. The undersigned 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 and safe practices as a major priority and insure that all actions including training, transporting, stalling, grooming and showing reflect that goal at all times. Contestant s Signature Date Parent s or Guardian s Signature Subscribed and sworn before me this day of, 20 My commission expires Notary Public Signature I hereby certify that the above entrant is an enrolled 4-H member by May 1, meeting all membership, age and eligibility requirements for the Oklahoma State 4-H District and State 4-H Horse Shows. County Extension Educator Signature Date Revised 02/12/2015

7 N.W. DISTRICT 4-H HORSE SHOW & RANCH HORSE SHOW ENTRY DUE DATE ~ FRIDAY, MAY 1, 2015 FOR ENTRY TO BE ACCEPTED: Horse Certification Form Entry Form must be filled out correctly and readable. [Example: Classes Entered must designate Horse A or B (if entering more than one horse.)] Policy Agreement/Release of Liability Form (Signed & Notarized) RAM Form Check (Made payable to: N.W. District 4-H Programs) All of the above items must be in the County Extension Office on Friday, May 1, County Mail to: N.W. District 4-H Office 205 W. Maple, Suite 510 Enid, OK Name: Phone: ( ) Age: (as of 1/1/2015) Address: Town: Zip: DIVISION: (Ages as of 1/1/2015) Junior (9-11) Intermediate (12-14) Senior (15-19) HORSE A INFORMATION NAME OF HORSE A: SEX: Mare Gelding COLOR: MARKINGS: BREED OF HORSE AGE AS OF 1/1/2015 REGISTRATION # (IF REGISTERED) HORSE B INFORMATION NAME OF HORSE B: SEX: Mare Gelding COLOR: MARKINGS: BREED OF HORSE AGE AS OF 1/1/2015 REGISTRATION # (IF REGISTERED) HORSE C INFORMATION NAME OF HORSE C: SEX: Mare Gelding COLOR: MARKINGS: BREED OF HORSE AGE AS OF 1/1/2015 REGISTRATION # (IF REGISTERED) ENTRY FEES: (Indicate classes on back using A or B in the blank to indicate the horse being used) 1st Class $ $5 X additional classes = $ Cattle Charge ($20 for each Horse show class 34, 35 and 36 and $20 for each Ranch Horse classes 1-6) $ AMOUNT OF CHECK $ MAKE CHECK PAYABLE TO: N.W. District 4-H Programs TOTAL $ Revised 02/12/2015

8 2015 NW DISTRICT 4-H HORSE SHOW CLASS ENTRY FORM CLASSES WILL BE TENTATIVELY SHOWN AS LISTED BELOW If more than one horse will be used, please indicate which horse in which class by using A - B in the blank before each class corresponding with front of entry form Halter Mares 5 years & younger (as of ) Halter Mares 6 years & older (as of ) Grand & Reserve Grand Mare Halter Geldings 5 years & younger (as of ) Halter Geldings 6 years & older (as of ) Grand & Reserve Grand Gelding Senior Showmanship 5E. English 5W. Western Intermediate Showmanship 6E. English 6W. Western Junior Showmanship 7E. English 7W. Western Senior Hunter Under Saddle Int. Hunter Under Saddle 10. Junior Hunter Under Saddle 11. Senior Hunt Seat Equitation 12. Int. Hunt Seat Equitation 13. Junior Hunt Seat Equitation 14. Senior Hunter Hack (15 & Over) 15. Jr. & Int. Hunter Hack (14 & Under) 16. Two Year Old Training Program Class 17. Senior Western Pleasure 18. Int. Western Pleasure 19. Junior Western Pleasure 20. Sr. Western Horsemanship 21. Int. Western Horsemanship 22. Jr. Western Horsemanship 23. Western Riding (All Ages) 24. Reining (All Ages) 25. Senior Barrel Race 26. Int. Barrel Race 27. Junior Barrel Race 28. Senior Pole Bending 29. Int. Pole Bending 30. Junior Pole Bending 31. Senior Stake Race 32. Int. Stake Race 33. Junior Stake Race 34. Breakaway Roping (15 & over) 35. Breakaway Roping (14 & under) 36. Tie Down Roping (All Ages) 37. Senior Trail 38. Int. Trail 39. Junior Trail Trail Arena (Open 10 a.m. to 3 p.m.) Revised 02/12/2015

9 2015 NW DISTRICT 4-H RANCH HORSE SHOW CLASS ENTRY FORM CLASSES WILL BE TENTATIVELY SHOWN AS LISTED BELOW If more than one horse will be used, please indicate which horse in which class by using A - B in the blank before each class corresponding with front of entry form. 1. Working Cow Horse Boxing only (15-19) 2. Working Cow Horse Boxing only (12-14) 3. Working Cow Horse Boxing only (9-11) 4. Ranch Roping (15-19) 5. Ranch Roping (12-14) 6. Ranch Roping (9-11) 7. Ranch Riding (15-19) 8. Ranch Riding (12-14) 9. Ranch Riding (9-11) 10. Ranch Trail (15-19) 11. Ranch Trail (12-14) 12. Ranch Trail (9-11) Revised 02/12/2015

10 2015 DISTRICT 4-H HORSE SHOWS POLICY AGREEMENT/RELEASE OF LIABILITY FORM POLICY AGREEMENT 1) No one other than the contestant is allowed to ride their project horse while at the District 4-H Horse Shows. 2) Horses are to be ridden only in designated riding areas (arenas, warm up areas). When practicing or showing, maintain a safe distance from horses, spectators and participants. Ride and practice with appropriate tack or clothes, (i.e. saddle, bridle, jeans, boots, helmet). 3) 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 for that person to have in their possession at the show. (Name of Responsible Adult accompanying youth (if different from the parent or guardian indicated below.) 4) Safe practices to protect yourself, other riders, spectators and show officials will be followed. To be eligible to participate, rules and policies as outlined in the 2015 Rules for Oklahoma 4-H District & State 4-H Horse Shows and the 2015 Ranchregarding show participation, safety, sportsmanship and class requirements will be followed by all participants, parents, leaders, and support persons of the youth. 5) Verbal complaints or objections by parents, leaders, and 4-Hers to any staff or volunteer of the N.W. District 4-H Horse Show means instant disqualification of the 4-Her in question from the remainder of the 2015 N.W. District 4-H Horse Show and that Show Director will not certify said 4-H member for State Show. 6) Should a 4-Her be disqualified, a written appeal may be submitted to the Appeals Committee and with their approval regain contestant status. 7) All appeals must be in writing, along with $50.00 cash and presented by the 4-H member filing the appeal. Protest form will be available from show management. 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 Northwest District 4-H Horse Shows sponsored by the Northwest District OSU Extension Office on June 9 & 10, 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. The parent or guardian is assuming the risk that their child and individual(s) attending the show with them are attending, working around and riding at their own risk. They are also acknowledging that they possess the appropriate knowledge and skills to handle, ride, and work around horses and equine equipment. They will not allow other individuals or animals who may or may not be familiar with horses to handle or be in a close area that may endanger participants, spectators, staff persons or animals. In further consideration of the Northwest 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 Northwest District 4-H/OSU Extension, Alfalfa County, Fair Board, the District Horse Council, all District Horse Show Officials, 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, Contestant s Signature SATE OF OKLAHOMA } } COUNTY OF } Parent s or Guardian s Signature The foregoing instrument was acknowledged before me on this day of, My commission expires: Commission Number: Notary Public Signature Revised 02/12/2015

11 NW DISTRICT 4-H HORSE SHOW VOLUNTEER HELP IS NEEDED from all counties to help and put on the NW District 4-H Horse Show. If you or someone from your club would help, please complete and return the form below with entry form or send directly to the N.W. District 4-H Office, 205 W. Maple, Suite 510, Enid, OK Name Day Phone Address, City & Zip Will help with (circle one or more): Gate Person Announcer Ring Secretary Timed Events Other (please specify) Times Available: Additional Information: Revised 2/12/2015

12 NW DISTRICT 4-H RANCH HORSE SHOW VOLUNTEER HELP IS NEEDED from all counties to help and put on the NW District Ranch Horse Show. If you or someone from your club would help, please complete and return the form below with entry form or send directly to the N.W. District 4-H Office, 205 W. Maple, Suite 510, Enid, OK Name Day Phone Address, City & Zip Will help with (circle one or more): Gate Person Announcer Ring Secretary Cattle Sorter Cattle Pusher Other (please specify) Times Available: Additional Information: Revised 2/12/2015

13 Oklahoma Cooperative Extension Service Northwest District 205 W. Maple Ave., Suite 510 Enid, Oklahoma Phone: Fax: To Whom It May Concern: We want to thank you for your interest in supporting our 4-H Youth Horse Program. The Northwest (NW) District is offering two educational and competitive events, the NW District 4-H Horse Show and the NW District 4-H Ranch Horse Show, both conducted by the Oklahoma Cooperative Extension Service which is an Extension of Oklahoma State University. We work with many Volunteers to give 4-H Youth a positive atmosphere to grow and compete with their Horse Projects. The NW District 4-H Horse Show is June 9, 2015 at Cherokee at the Alfalfa County Fairgrounds. The NW District 4-H Ranch Horse Show will be held June 10, 2015 at the same location. Your support will be greatly appreciated and will help us conduct the NW District Horse Shows. Your donation is tax deductible and you will receive a receipt to assist you with your records. Checks should be made payable to: NW District 4-H Horse Show. If you would like your donation to go to a specific part of the show, please notate that on your check. We will certainly publicize your generosity with our participants and their families. They will all be so appreciative of your support! We want to thank you again for your kind support that will help us continue to build strong leaders for our future. We will be able to keep Making the Best Better through 4-H. Respectfully yours, Jim Rhodes NW District 4-H Youth Development Program Specialist Oklahoma State University, U. S. Department of Agriculture, State and Local governments cooperating. Oklahoma State University in compliance with Title 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 FORM 1 Oklahoma State University 4-H Youth Development Informed Consent, Voluntary Waiver, Release of Liability & Assumption of Risks Form PROGRAM/CAMP INFORMATION Program/Camp/ Trip/ Event Name: Date(s): Location: PARTICIPANT INFORMATION Name of Participant: Time(s): Address: City: State: Zip: Phone Number: Date of Birth: Gender: M F PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. THIS IS A LEGALLY BINDING DOCUMENT. THIS FULLY SIGNED FORM MUST BE SUBMITTED BY A PARENT OR LEGAL GUARDIAN BEFORE ANY CHILD IS ALLOWED TO PARTICIPATE IN THE ABOVE REFERENCED PROGRAM/CAMP/TRIP/EVENT SPONSORED BY 4-H 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. I furthermore understand that an accident insurance policy carried by American Income Life h-insurance#fourh Plan #, if any, will provide only minimum coverage. 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 not amererecital. 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. DATE OF EFFECT: I agree to the terms listed UNTIL DECEMBER 31, 20, or until such time that I am asked to complete a new or revised Consent Form. Participant Name (PRINT) Parent/Guardian Name Date Participant Signature Parent/Guardian Signature Date A PARENT OR GUARDIAN MUST SIGN THIS FORM FOR A MINOR UNDER THE AGE OF 18

15 OKLAHOMA 4-H CODE OF CONDUCT Oklahoma State University Rules and Disciplinary Procedures FORM 2 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 to become effective on June 1, All rules and regulations governing an activity or event will be discussed with educators, leaders and 4-H'ers prior to or at the beginning of each event. 2. All 4-H'ers are under the supervision of any Extension worker or adult assigned to the event. II. 4-H members accused of any of the following may be sent home immediately and will be required to appear before a review board: - Assault or personal harm - Possession or use of illegal drugs or alcoholic beverages - Sexual misconduct - Theft, misuse or abuse of public or personal property - Possession of weapons (does not limit the use of approved sporting arms when and where authorized). If a question regarding any the above is raised, 4-H members consent to a search of their room and/or personal property. Failure to comply will result in violation of the Code of Conduct. III. 4-H members accused of any of the following may be sent home and may be required to appear before the review board: - Breaking curfew, disturbing the peace or violating the dress code - Use of abusive language - Unexcused absence from the activities of the event - Possession of illegal fireworks - Unauthorized use of vehicles during the event - Misuse of internet or other technology - Unauthorized absence from the premises of the event If the accused 4-H'er is found in violation and receives discipline issued by the review board, his or her parent/guardian will be notified, and the 4-H'er may be sent home immediately at the parents expense and may be suspended from participating in district, state, national and international 4-H activities for up to six (6) months. a. 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 Educator or the Program Director. 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 Extension Educators or the Program Director for the duration of the program. For events on campus all vehicles parked on campus must have a University Parking Permit. Parking permits will be issued during on-site registration, and clear instructions will be given as to where parking is authorized. It will be the responsibility of the participant to secure a permit, properly place the permit in the vehicle, park the vehicle in an authorized space, and turn the keys into the Program Director for safe keeping during the program. Neither Oklahoma State University, nor the program staff, will be responsible for damage to vehicles or for any parking tickets, fines, or towing charges that result from violations. b. Participants are to remain on the event site for the duration of the program unless program activities require otherwise. If a participant needs to leave campus or event site for some reason, Supervising Extension Staff must receive prior written permission from the parent or guardian, and grant specific permission. c. Campus regulations prohibit the use of alcohol, tobacco, and other illegal substances. Participants may not possess, use, distribute, or sell alcoholic beverages, tobacco, drugs, firearms, weapons or fireworks. d. Coed visitation in the residence halls is permitted in designated common areas only not in sleeping rooms. No boys will be allowed in girls rooms nor will girls be allowed in boys' rooms, either as individuals or groups. It is recognized that circumstances may arise for justifiable exceptions to this policy. However, in every case, permission for exceptions must be secured from chaperone in advance. e. Participants must attend all workshops, classes, and planned social or recreational activities. Full participation is the only way a participant can gain value from the Program.

16 f. Participants will abide by nightly curfews and Lights Out announcements from the Program Director or Program Counselors. Participants must be in their OWN room at lights out and remain there until morning. g. Participants must never misuse internet or cell phone privileges. Attempting to access unauthorized sites is strictly prohibited. h. Participants must abide by rules and guidelines set by the instructors for each facility in use. i. In accordance with state law, smoking and use of other tobacco products is prohibited by any one under the age of 18. Neither smoking nor any other tobacco use is permitted at Oklahoma State University or at any of its remote or affiliated sites or programs; OSU is proud to be a tobacco-free campus. j. Any individual found tampering with any fire equipment (i.e. fire extinguishers, fire alarms, smoke detectors, etc.) will be dismissed from the Program immediately. Participants may not interfere with any security system or tamper with locks in participant rooms and other areas. k. All furniture must remain unchanged and kept in place. FORM 2 l. Vandalism and pranks will not be permitted. Any damages caused in rooms or common areas will be charged to the responsible party. Replacement cost will be charged to anyone who removes or damages property. m. Participants should keep their rooms locked at all times even if leaving the room for only a few minutes. Neither Oklahoma State University, nor the event staff, is responsible for lost or stolen items. A participant should take their room key when leaving room. Those who lose a key must pay for a replacement. Leave excess money and valuables at home. Valuables, including jewelry, ipods, cellphones, electronics, etc., may be brought to the Program, but only at Participants own risk and can only be used at free or other authorized times. Disciplinary Procedures: 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 impact negatively on the program experience of others. Most programs are short in duration, so prompt action is required when problems occur. Parents and participants should be aware of the disciplinary policy. First Offense: Participants failing to adhere to program rules, or exhibiting behavior clearly intended to annoy or endanger other participants, will be formally warned by event staff and informed that subsequent misbehavior will result in additional disciplinary action. Second Offense: Subsequent misconduct will result in counseling by the staff in charge of the event and a warning that further misconduct will result in a Review Board Hearing or removal from the Program. At this point, the County Educator or Supervising Staff will contact the parent or guardian to advise him/her of the situation and the possible need for picking the child up from the event if there is further misconduct. Third Offense: Any further inappropriate behavior will result in expulsion from the event and may result in not being able to attend other programs in the future. If the 4-H'er is found in violation of the Code of Conduct and receives discipline issued by the review board his or her parent/guardian will be notified immediately; the 4-H'er will be suspended from participation in district, state, national and international 4-H activities for a period for up to twelve 12 months and may be sent home immediately at parent s expense. NOTE: OKLAHOMA STATE UNIVERSITY EXPECTS EACH PARTICIPANT TO HAVE A SUCCESSFUL PROGRAM EXPERIENCE. ANY OF THE STEPS OUTLINED ABOVE MAY BE OMITTED OR REPEATED AT THE DISCRETION OF PROGRAM STAFF. PARTICIPANTS DISMISSED FROM A PROGRAM FOR DISCIPLINARY REASONS WILL NOT RECEIVE A REFUND OF ANY FEES PAID TO ATTEND PROGRAM AND MAY NOT BE ALLOWED TO ATTEND FUTURE PROGRAMS OR EVENTS. STAFF NOTIFICATION PROCEDURES: at state, regional, national, international events; If a 4-H'er is found in violation of the Code and is to be sent home, the person in charge of the event will notify the appropriate County, District or State 4-H Office. REVIEW BOARD: The person in charge of the event will appoint a review board at the beginning of the event. The review board will consist of the following:

17 FORM 2 At least one Extension Educator, up to two Volunteer Leaders and three 4-H members (The person in charge of the event or delegation shall serve as chairman.) The review board may be convened by the person in charge of the event/delegation, or at the request of the affected 4-H'er. APPEAL PROCEDURES: If a 4-H'er wishes to appeal the decision of the review board, 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. The appeal board who hears the appeal of the 4-H member shall consist of: H members MAY be included based on the situation - A County Extension Educator - A 4-H Volunteer - District 4-H Specialist Realizing these guidelines are not all inclusive, the Extension Service reserves the right to make adjustments to policies. It should be understood this procedure is intended to provide a reasonable and consistent method for dealing with the type of behavior that can be disruptive to a program, but is not so egregious as to warrant immediate dismissal from the program. It in no way precludes immediate dismissal from the program for more serious disciplinary problems or violations of campus or 4-H program regulations. A serious disciplinary problem is defined as one in which the program staff determines that a child is engaging in inappropriate behavior that includes, but is not limited to the following: actions which put the participant, other participants, or program staff member s safety in jeopardy; physical, emotional, or electronic harassment/harm against self, program staff or fellow program participants; inflicting physical or emotional harm on self or others, vandalism or destruction of University property; theft of University property or the property of another participant; consistently disrupting the program; possession of alcohol, tobacco, drugs, or weapons; fighting; sexual harassment; or behavior that is serious enough to warrant a third offense. Parent and Student Pledge: As a condition of participation in 4-H events, we agree to be bound by the terms of the 4-H Code of Conduct. We understand the reason for this agreement is to insure conduct and behavior that will result in every 4-H delegate receiving the full benefit of enjoyment and educational experience from this event and is not intended to place undue restriction upon any individual. I/we understand the disciplinary procedures described above. I/we understand failure to demonstrate proper conduct during the program or event may result in early dismissal without any refund of fees paid to attend. We pledge to abide by all program rules and to exercise good behavior and proper respect for others. DATE OF EFFECT: I agree to this pledge of conduct through DECEMBER 31, 20 or until such time that I am asked to complete a new or revised Code of Conduct. 4-H Member Signature Date Parent or Guardian Signature County Extension Educator County (NOTE: Failure to have the bonafide signatures above shall be sufficient reason to disqualify a member from further participation in a 4-H event. Please return entire page by designated date.) Address Phone Where Parent or Guardian may be reached

18 NW District 4-H Horse Show and Ranch Horse Show Check Sheet Make sure everything is signed, notarized and in by the due dates! Legible Copy of Notarized Lease Agreement if Horse is leased Horse Certification Form 4-H Horse Show & Ranch Horse Show Entry Forms Code of Conduct Forms 1 & 2 Policy Agreement/Release of Liability Form Check made out to: NW District 4-H Programs and attached to entry Copies for your records Don t Forget!! Bring a current negative Coggins Certificate for each horse the day of the show.

19 North West East Fairgrounds South