SE DISTRICT AIRFIELD 4-H SUMMER HORSE CAMP August 13 19, 2017

SE DISTRICT AIRFIELD 4-H SUMMER HORSE CAMP August 13 19, 2017 HORSE CAMP IS A MEANS BY WHICH CAMPERS CAN IMPROVE THEIR HORSE KNOWLEDGE AND HORSEMANSHIP SKILLS. THE PURPOSE OF HORSE CAMP IS NOT TO TRAIN GREEN RIDERS AND/OR MOUNTS. CAMPERS ARE EXPECTED TO ALREADY HAVE THE BASIC KNOWLEDGE NEEDED FOR THE TYPE OF INSTRUCTION THEY CHOOSE. WHAT TYPE OF RIDING INSTRUCTION AND WHAT IS EXPECTED DURING THE INSTRUCTION: HUNT SEAT: MOUNTS IN THIS BLOCK OF INSTRUCTION WILL BE REQUIRED TO WALK, TROT, AND CANTER. IT IS UP TO THE CAMPER AS TO WHETHER THEY WANT TO JUMP. HUNT TACK AND HELMETS REQUIRED. WESTERN PLEASURE: MOUNTS IN THIS BLOCK OF INSTRUCTION WILL BE REQUIRED TO WALK, JOG, AND LOPE. INSTRUCTOR WILL WORK WITH CAMPERS ON EQUITATION, PATTERNS, AND RAIL WORK. WESTERN TACK AND HELMETS REQUIRED. GYMKHANA(SPEED): CAMPERS WILL LEARN THE PROPER WAY TO BARREL RACE, POLE BEND AND STAKE RACE DURING THIS BLOCK OF INSTRUCTION. ANIMALS IN THIS SECTION MUST BE ABLE TO WALK, JOG, AND LOPE. CAMPERS SHOULD BE ABLE TO CONTROL THEIR MOUNTS AT ALL TIMES. WESTERN TACK AND HELMETS REQUIRED. MINIATURE HORSE: Campers will wrk with their miniature hrse in learning prper handling and care. They will have lessns in cmpeting with the special little hrse. Trail bstacle jumping curse and ther events. WE ARE NOT ABLE TO OFFER INSTRUCTION OTHER THAN THAT LISTED ABOVE. MOUNTS MUST BE SUITABLE FOR ONE OF THE ABOVE BLOCKS OF INSTRUCTION. 1

NOTE IN REFERENCE TO EIGHTEEN (18) YEAR OLDS: IT HAS BEEN SUGGESTED THAT WE ALLOW 18-YEAR OLDS TO ATTEND AS CAMPERS AGAIN. THIS CAN BE DONE IF WE HAVE ENOUGH INTEREST TO ROOM AT LEAST TWO (2) EIGHTEEN YEARS OLDS IN THE SAME ROOM. THEY WILL NOT BE TEEN COUNSELORS AND BE ALLOWED TO PARTICIPATE IN BRINGING A HORSE AND ALL ACTIVITIES. 4-H HORSE CAMP IS A SPECIAL INTEREST 4-H CAMP FOR BOYS AND GIRLS WHO WANT TO IMPROVE THEIR HORSE KNOWLEDGE AND HORSEMANSHIP SKILLS. THE CAMP IS A CONCENTRATED COURSE WITH INSTRUCTION COVERING WESTERN,HUNT SEAT, AND GYMKHANA MINIATURE HORSE TECHNIQUES. IN ADDITION TO THE RIDING INSTRUCTION CAMPERS PARTICIPATE IN A VARIETY OF CLASSROOM LEARNING ACTIVITIES RELATING TO HEALTH, CARE, EQUIPMENT, CLINICS AND OTHER TOPICS. HORSE CAMP PROVIDES YOUNG HORSE PEOPLE AN OPPORTUNITY TO MEET AND ENJOY THE FELLOWSHIP OF OTHER 4-H'ERS AND VOLUNTEERS FROM DIFFERENT AREAS OF THE DISTRICT AND STATE. CAMPER QUALIFICATION 4-Her s MUST BE 9 YEARS AS OF AGE AS OF SEPTEMBER 30TH 0F THE CURRENT YEAR. ANYONE WHO TURNS 18 YEARS OF AGE PRIOR TO OR DURING THE CAMPING WEEK ARE INELIGIBLE (WITH THE EXCEPTION - SEE NOTE ON PAGE 2, IF ENOUGH INTEREST WE COULD HAVE 18 YEAR OLDS ATTEND IF THERE IS AT LEAST 2 THAT CAN SHARE A ROOM), SINCE HORSE CAMP NOW HAS TEEN COUNSELOR POSITIONS FILLED BY 18-YEAR OLDS. MUST ALSO BE ENROLLED IN THE 4-H HORSE PROJECT AS OF MAY 1ST OF THE CURRENT YEAR. CAMP FEES--$450.00 INCLUDES MEALS, LODGING, SWIMMING AND RECREATION, STABLING, RIDING INSTRUCTION, RIDING RINGS, CRAFTS, LITERATURE, AND PERSONAL ACCIDENT INSURANCE. THE FULL CAMP FEE IS DUE TO HOLD A SPACE AND MUST BE RECEIVED BY JULY 1, 2017. CHECKS SHOULD BE MADE PAYABLE TO THE "SOUTHEAST DISTRICT HORSE LEADER'S ASSOCIATION." ALL OF THE REGISTRATION FEE, EXCEPT A $35.00 NON-REFUNDABLE OFFICE CHARGE, WILL BE REFUNDED UNDER THE FOLLOWING CONDITIONS PRIOR TO JULY 5, 2017. 1) PROJECT ANIMAL IS LAME OR SICK AND THE CONDITION IS VERIFIED BY A DATED VETERINARIAN'S CERTIFICATE. 2) 4-H'ER IS SICK AND ILLNESS IS VERIFIED BY THE ATTENDING PHYSICIAN'S CERTIFICATION. 3) DEATH IN 4-H'ERS FAMILY OR OTHER SERIOUS EMERGENCY. NO MONIES WILL BE REFUNED IF A CAMPER LEAVES CAMP NO MATTER WHAT THE REASON. THERE WILL BE A $35.00 CHARGE FOR RETURNED CHECKS. APPLICATIONS ALL 4-HERS FROM THE SOUTHEAST DISTRICT WILL BE ACCEPTED AS LONG AS THEIR APPLICATIONS ARE RECEIVED BY JULY 1, 2017, THE REMAINING OPENINGS WILL BE FILLED ON A FIRST COME, FIRST SERVE BASIS. HORSE CAMP IS LIMITED TO 70 CAMPERS. IF APPLICATIONS EXCEED QUOTA, A WAITING LIST WILL BE DEVELOPED. CAMPERS WILL BE NOTIFIED OF THEIR ACCEPTANCE. HEALTH OF ANIMALS--A NEGATIVE (LEGIBLE) COGGINS TEST, DATE BLOOD WAS DRAWN MUST BE WITHIN ONE YEAR AND TWO DAYS AFTER CAMP ENDS, MUST ACCOMPANY APPLICATIONS. A VETERINARIAN WILL BE ON CALL FOR THE CAMPING PERIOD TO 2

TREAT ANY SICKNESS OR INJURY TO YOUR HORSE. VETERINARIAN FEES.) (OWNERS ARE RESPONSIBLE FOR ALL SAFETY--SAFETY WILL BE EMPHASIZED AT ALL TIMES. CAMPERS ARE REQUIRED TO WEAR PROTECTIVE HEADGEAR AT ALL TIMES WHILE MOUNTED. A CAMP INFIRMARY AND NURSE WILL BE AVAILABLE AT ALL TIMES TO HANDLE ANY CAMPER EMERGENCIES. CAMPERS MUST PROVIDE--THEIR OWN HORSE, TACK, GROOMING EQUIPMENT, HAY AND GRAIN, FEED AND WATER BUCKETS, FLY WIPE, ETC. CAMPERS CAN BRING ONLY ONE HORSE. CAMPERS MUST PROVIDE THEIR OWN STALL CLEANING EQUIPMENT. ALL CAMPERS WITH HORSES MUST BRING SUFFICIENT BAGS OF SHAVINGS FOR THE INITIAL BEDDING OF THEIR STALL AND RE-BEDDING THROUGHOUT THE WEEK INSURANCE--NO COVERAGE IS PROVIDED FOR HORSES OR EQUIPMENT. DAMAGE OR INJURY IS AT THE OWNER'S RISK AND EXPENSE. ANY LOSS, IF YOU HAVE ANY QUESTIONS CONTACT BROOKE MCCALL,(757)773-4270 OR BY EMAIL SEABREEZEPONIES@YAHOO.COM RETURN THE FOLLOWING WITH THE $355.00 REGISTRATION FEE: REGISTRATION FORM CAMP GUIDELINES AND PERMISSION FORM HORSE HEALTH CERTIFICATE COPY OF UP-TO-DATE COGGINS (LEGIBLE) 4-H'ERS HEALTH FORM BOTH SIDES AIRFIELD 4-H CENTER MEDICATION FORM BOTH SIDES EQUINE WAIVER CODE OF CONDUCT BOTH SIDES MAIL TO: (SPECIAL MAILING MAY DELAY RECEIPT, SINCE THERE IS NOT ANYONE AVAILABLE DURING THE DAY TO SIGN FOR MAIL, PLEASE MAIL EARLY) BROOKE MCCALL 1004 HEAD OF RIVER ROAD CHESAPEAKE VA 23322 3

REGISTRATION FORM SE DISTRICT AIRFIELD 4-H SUMMER HORSE CAMP AUGUST 13 19, 2017 4-H'ERS NAME SEX: FEMALE / MALE (CIRCLE NAME YOU WISH TO BE CALLED) COMPLETE MAILING ADDRESS ZIP TELEPHONE (HOME) (INCLUDE AREA CODE) BIRTHDATE AGE (MONTH/DAY/YEAR) SHIRT SIZE (Adult) S M L XL PARENT/GUARDIAN WORK PHONE (INCLUDE AREA CODE) PARENT S EMAIL 4-H CLUB HOW LONG A MEMBER WHAT SECTION DO YOU WISH TO PARTICIPATE IN (CIRCLE ONLY ONE) WESTERN HUNTER SPEED MINIATURE HORSE HUNTER RIDER SKILL LEVEL: CIRCLE ONLY ONE PARENT MUST INITIAL HERE ( ) ON THE FLAT JUMP UP TO 18 INCHES JUMP UP 2 6 ROOM AND STALL ASSIGNMENTS WILL BE MADE BEFORE YOU ARRIVE AT CAMP. ATTEMPT TO PUT YOU WITH THE PEOPLE YOU LIST BELOW: WE WILL LIST NAMES OF PERSONS YOU WANT TO ROOM WITH: GIRLS MAY HAVE TO SHARE A DOUBLE BED WITH SOMEONE THEY KNOW. LIST NAMES OF PERSONS YOU WANT TO STABLE WITH: Virginia Cperative Extensin Service prgrams, activities, and emplyment pprtunities are available t all peple regardless f race, clr, religin, sex, age, natinal rigin, handicap, r plitical affiliatin. AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER 4

CAMP GUIDELINES AND PERMISSION FORM - RIDERS SE DISTRICT AIRFIELD 4-H SUMMER HORSE CAMP AUGUST 13 19, 2017 The abve 4-H activity r event is planned, cnducted and supervised by the Cperative Extensin Service. All 4-H'ers are respnsible fr their cnduct t Extensin persnnel and/r 4-H leaders supervising the activity r event. Camp guidelines fr cnduct include: 1) 4-H'ers shall be in their rms and quiet at the time determined by Extensin persnnel and leaders. 2) 4-H'ers shall participate fully in all prgrams utlined fr the activity r event. 3) 4-H'ers shall shw respect fr the prperty and facilities used during the activity r event and assume financial respnsibility fr any damages they cause. 4) 4-H'ers cnduct at all times shall be apprpriate t the standards and image f the 4-H prgram. Agreeing t abide by the rules f the Center and d my best at all times t be a gd camper, I hereby apply t attend the Airfield 4-H Hrse Camp. 4-H MEMBER'S SIGNATURE DATE This applicatin has my apprval. It is agreed that camp fees will be paid in advance and will nt be refunded in case a child leaves camp fr any reasn. It is agreed that the camp management reserves the right t dismiss a child (withut refund), if necessary. While the camp takes every reasnable precautin, it is agreed that camp assumes n respnsibility fr camper's persnal prperty and is released frm liability in cnnectin with medical administratin except as cvered by camper insurance. In giving my permissin fr my child t attend the Airfield 4-H Hrse Camp, I agree t indemnify the Airfield 4-H Center, their staff, 4-H leaders, and Extensin Agents, spnsrs and instructrs f the Airfield 4-H Hrse Camp against any claim r liability fr damage caused by him r his hrse. I als understand that n accident insurance will be prvided fr the hrse. I CERTIFY THAT MY CHILD IS CAPABLE OF COMPLETELY TAKING CARE OF HIS/HER HORSE TO INCLUDE TACKING UP, WITH NO ASSISTANCE AND THAT THEY ARE ALSO ABLE TO HANDLE HIS/HER HORSE WHILE MOUNTED AND DISMOUNTED. I CERTIFY THAT THE ABOVE NAMED 4-H'ER HAS BEEN ENROLLED IN THE 4-H HORSE PROGRAM SINCE MAY 1, 2013 AND THE CLUB LEADER IS SIGNING BELOW STATING THAT THE 4-H er IS FULLY CAPABLE TO CARE AND HANDLE THEIR HORSE FOR A WEEK AT CAMP. PARENT/GUARDIAN SIGNATURE DATE 4-H CLUB LEADER DATE FORMS AND MONEY WILL BE RETURNED IF ANY OF THE ABOVE SIGNATURES ARE MISSI 5

HEALTH RECORD FOR HORSE PARTICIPATING IN 4-H ACTIVITIES SE DISTRICT AIRFIELD 4-H SUMMER HORSE CAMP AUGUST 13 19, 2017 CAMPER'S NAME OWNER'S NAME OWNER'S ADDRESS DATE OF LAST VETERINARIAN EXAMINATION HORSE'S NAME SEX OF HORSE BREED AGE OF HORSE DESCRIPTION (COLOR) (MARKINGS) NEGATIVE COGGINS TEST REQUIRED (DATE OF TEST) (CONTROL NUMBER) VACCINATIONS (GIVE DATE GIVEN): EASTERN & WESTERN EQUINE ENCEPHLOMYELITIS (REQUIRED) VENEZUELAN EQUINE ENCEPHLOMYELITIS (OPTIONAL) TETANUS (REQUIRED) FLUVAC (OPTIONAL) STRANGLES (OPTIONAL) RABIES (REQUIRED) HORSE IS ON THE FOLLOWING MEDICATION GENERAL INFORMATION (IS THIS ANIMAL INCLINED TO "COLIC" OR "TIE UP" EASILY ETC. OR HAS ANY BEHAVIORAL PROBLEMS (KICKING, BITING, ETC. EXPLAIN) AS OWNER OF THE HORSE, I CERTIFY THAT THE ABOVE-NAMED HORSE HAS HAD THE REQUIRED TESTS AND VACCINATIONS AND IS IN GOOD HEALTH TO PARTICIPATE IN THE ACTIVITES REQUIRED IN ATTENDING THE AIRFIELD 4-H HORSE CAMP AND HAS BEEN IMMUNIZED AGAINST THE ABOVE ILLNESSES. I ALSO ACCEPT RESPONSIBILITY FOR ANY VET BILLS INCURRED DURING CAMP. OWNER OF HORSE (PRINT NAME) OWNER OF HORSE (SIGNATURE) THE FOLLOWING SIGNATURE IS REQUIRED IF OWNER IS UNDER 18 YEARS OF AGE CAMPER'S PARENT (PRINT NAME) CAMPER'S PARENT (SIGNATURE) UNIT: SE DISTRICT AIRFIELD 4-H SUMMER HORSE CAMP YEAR: AUGUST 13 19, 2017 6

VIRGINIA 4-H STANDARDIZED CODE OF CONDUCT FOR 4-H PROGRAMS/EVENTS Purpse The purpse f the 4-H prgram is the psitive develpment f yuth. We believe in creating a safe learning envirnment that encurages the fur-fld develpment f a yung persn (i.e., Head, Heart, Hands, and Health). We expect all persns invlved in 4-H (yuth members, parents, teen/adult vlunteers) t practice behavirs that fster the ttal develpment f yuth. Each 4-H member and assciated individuals participating in 4-H activities must accept the respnsibility f creating a psitive image that reflects 4-H ideals. Furthermre, the Virginia 4-H prgram recgnizes that CHARACTER COUNTS! All 4-H participants are representatives f the prgram and shuld always strive t uphld the fllwing standards: Trustwrthiness, Respect, Respnsibility, Fairness, Caring, and Citizenship. In seeking unifrmity in the cnduct expected at 4-H prgrams/events, the fllwing cde f cnduct has been develped t prvide a clear understanding f expectatins. Participants and parents/guardians must sign this frm in rder t participate. Cde f Cnduct 1. Fr the safety and wellness f all participants, a cmpleted and signed 4-H Health Histry Reprt Frm is required fr participatin in 4-H events. In additin, medicatins and medicatin frms (fr all participants under 18 years ld) must be turned in at the registratin table upn arrival at the 4-H event (r accrding t anther system utlined in the registratin/rientatin infrmatin). 2. Participants shuld attend and be actively invlved in all scheduled activities as part f this 4-H prgram/event (unless under the supervisin f a medical staff persn.) Curfew is t be fllwed as specified in the schedule fr vernight events. Failure t be in assigned lcatins may lead t dismissal frm the 4-H event. Sme areas are fflimits t participants (ex: swimming pl; bdies f water such as lakes and rivers; challenge curse, etc.) unless under apprpriate instructr supervisin. 3. Visitrs t a 4-H prgram/event must check-in with the Extensin Agent, Prgram Directr, r ther adult in charge f the 4-H prgram/event upn arrival. 4. Participants shuld remain at a 4-H prgram/event until the prgram/event is scheduled t end. Participants may nt leave a 4-H prgram/event withut prir permissin frm Extensin Agent, Prgram Directr, r ther adult in charge f the 4-H prgram/event. Participants may nly be picked up frm a 4-H prgram/event by the persn designated n the 4-H Health Histry Reprt Frm. Identificatin may be requested at the time f pick-up. 5. Participants are expected t fllw the directins f 4-H vlunteers and paid staff. All 4-H ers are under the supervisin f the Extensin Agent, Prgram Directr, r ther adult 4-H leader respnsible fr the 4-H prgram/event. 6. Participants shuld respect the prperty f thers and be respnsible fr themselves. Deliberate destructin r remval f facilities r equipment is nt permitted. Financial respnsibility fr any damages caused by deliberate destructin will be assumed by the participant and/r parents/guardians. The same applies t the prperty and persnal items f ther participants. 7. Participants shuld treat all thers and themselves with respect. Aggressive, abusive, vulgar, r vilent language and behavir twards thers (ex: fighting, threats, insults, cursing, discriminatin, etc.) are nt permitted. 8. Participants shuld respect the privacy f thers. Girls are nt permitted in bys ldging rms nr are bys permitted in girls ldging rms. 9. Participants are expected t dress apprpriately based upn the guidelines established by the persn in charge f the 4-H prgram/event. 10. Pssessin, distributin, r use f firewrks, weapns, knives, r ther items that can be used as a weapn are nt permitted at 4-H prgrams/events, except under adult supervisin in scheduled instructinal activities (ex: shting educatin class supervised by a certified instructr, etc.). 11. Pssessin, distributin, r use f alchlic beverages, illegal drugs, tbacc prducts, and unauthrized Prescriptin drugs are nt allwed at any 4-H spnsred prgram/event and must be reprted t law enfrcement. 7

The Virginia 4-H prgram reserves the right t cnduct a search f a participant s uter clthing, luggage, persnal belngings, ldging rms, and furniture being used by a participant(s) if there is reasnable suspicin that the participant has drugs, alchl, r weapns. 12. Animals and pets are nt allwed at 4-H prgrams/events unless needed t accmmdate a disability r as part f an rganized prgram, r thrugh specific authrizatin frm Extensin Agent, Prgram Directr, r ther adult in charge f the 4-H prgram/event. Animals that are used as part f a 4-H prgram/event shuld always be prvided with prper care. 13. Electrnic and mechanical devices (ex: cellular phnes, pagers, walkie-talkies, vide games, radis, CD players, TV s, laptp cmputers, etc.) are nt allwed at 4-H prgrams/events unless they are needed as part f an rganized 4-H prgram/event, r with authrizatin frm the Extensin Agent, Prgram Directr, r ther adult in charge f the 4-H prgram/event. Withut authrizatin, these items will be cnfiscated and returned t the participant (r the participants parents/guardians) at the end f the prgram/event. Cnsequences Unacceptable behavir during a 4-H prgram/event (as defined within this Virginia 4-H Standardized Cde f Cnduct r thrugh a review prcess by 4-H staff/vlunteer) will result in cnsequences t the participant. Cnsequences may include: 1. early release frm this 4-H prgram/event withut refund, 2. restitutin r repayment f damages, 3. denial f future participatin in the 4-H prgram/event at the lcal, district, state and natinal levels fr ne r mre years (as determined by the unit staff in charge f, r respnsible fr, the 4-H prgram/event), 4. frfeiture f financial supprt fr a 4-H prgram/event 5. remval frm 4-H ffices held (if applicable), and 6. releasing the yuth t the apprpriate law enfrcement agency and/r the prper authrities. NOTE: Any cnduct nt specifically cvered by this Virginia 4-H Standardized Cde f Cnduct, but deemed inapprpriate by thse respnsible fr the 4-H prgram/event will be viewed as a vilatin and apprpriate actin will be taken. If an infractin ccurs, the persn in charge f the 4-H prgram/event will prvide apprpriate cmmunicatin t parents/guardians. VIRGINIA COOPERATIVE EXTENSION PERIODICALLY USES PHOTOGRAPHS, VIDEO, AUDIO FOOTAGE OR TESTIMONIALS OF 4-H MEMBERS FOR LOCAL, REGIONAL, OR STATE EDUCATION PURPOSES. I GIVE PERMISSION FOR THE SE DISTRICT 4-H HORSE LEADER S ASSOCIATION TO USE SUCH REPORDUCTIONS FOR EDUCATION PURPOSES. Signature(s) (Bth signatures are required fr participants under 18 years ld.) I have read and understand the abve Cde f Cnduct and will abide by the expectatins described in the Cde-f- Cnduct. I understand that if I act inapprpriately I will have t accept respnsibility fr my actins that may result in the cnsequences listed abve. Participant Printed Name Participant Signature Date I have discussed and reviewed this Cde f Cnduct with my child. I understand that failure t abide by this Cde f Cnduct may result in the cnsequences listed abve which includes n refund. In the event that this cde is vilated, I agree t cme t the 4-H prgram/event t pick up my child at the request f the adult in charge f the 4-H prgram/event. I further understand that I refuse t pick up my child, am unavailable, r fail t make timely arrangements t retrieve my child, 4-H prgram/ event staff may cntact law enfrcement r scial services t prvide necessary prtectin fr a child in need f services. I acknwledge respnsibility fr all fees/charges that may result frm said services. Signatures fr participants under 18 years. Parent/Guardian s Printed Name Parent/Guardian s Signature DATE 8