Area Horse Show Registration Form

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					                                        2011 Area B 4-H Horse Show Registration Form

     All entry fees must a ccompany this form.
     Before filling out this entry form, consul t the offi cial rules if you ha ve ques tions about the requi rements or procedures for any cl ass
     Sta tement on reverse mus t be signed
     Ponies will be measured on show grounds by a show committee member a t a speci fied time Frida y and Sa turda y.
     The show will be held on the da te s cheduled ba rring a na tural ca tastrophe. It is the responsibility of the exhibi tors ’ pa rents or
              gua rdians to determine i f they a re able to compete safel y. In case of inclement wea ther, all contes tants should realize tha t
              the condi tions and fa cilities a re the best a vailable as determined by the show management and mus t a ccept these condi tions
              and show a ccordi ngl y.
     No class changes will be allowed except in ins tances where height requi rements or limi tations a re not met. It is the responsibility of
                 the exhibitor and pa rent/guardian to verify the correctness of entries before signing and submi tting.

                                                           EXHIBITOR’S INFORMATION

First Name:                                                          Last Name:                                          Date of Birth: 01/01/00

Age as of September 1, 2010: Choose One                              Phone: 000-000-0000                                 Age Group: Choose One

Current Address:

City:                                                                State: Florida                                      ZIP Code: 00000-0000
E-mail:                                                              Club Name:                                          County: Choose One
I will represent my county and help clean up after the show on Friday or Saturday. (please circle which) Sign in at Registration Office.
Emergency Contact Number #1: 000-000-0000                                         Emergency Contact Number #2: 000-000-0000

                                                               CLASS REGISTRATION

Horse’s Name:                                               Horse’s Age                                                  Pony Height Hands

             Maximum entries per Exhibitor: five classes – if entering five classes one must be showmanship.
             Exhibitor can only enter one halter class.
                                                         Class #     Class Name
First Class

Second Class

Third Class

Fourth Class

Showmanship Class (class #5,6,20,21,32,or 33 )


                                                                  FEES & PAYMENTS
Item                                                                                                                           Quantity            Total
Entry Fee $40 per Exhibitor                       (Entry fee was $50.00, Area B Committee paid $10 tow ards entry fee)         1                   $40.00

Stall Fee – $20 per Horse                                                                                                                          $0.00

Stall Fee – $20 per Tack                                                                                                                           $0.00

RV hookup $30 per site                                                                                                                             $0.00

T-shirts @ $12                                                                                                                                     $0.00

Please make check payable to: who YOUR County Extension Office requires.                                  Grand Total:                             $0.00


 Shavings – a separate flyer will                                                                                        X         XX        Total     Total
                                                                          Group       Small     M edium       Lar ge
 follow registration regarding shavings                                                                                  Lar ge    Lar ge    S hirts   C ost
 PRE-ORDER: Friday Dinner @$6 per                                         Youth                                                                        $0.00
                                                   dinners
 plate, to be paid at show
                                                                          Adult                                                                        $0.00


Special Stall Request (requests may or may not be accommodated as seen fit be the show committee)



                                           2011 Area B 4-H Horse Show Registration Form 1 of 3
Yes /No             Statement
                    I,      , understand that it is my responsibility to muck my horse’s stall, wash/clean my horse and care for my horse,
Yes or No
                    not that of my parent’s and/or guardian.
                    In order to allow as many qualified youth to participate in the Sta te 4-H Horse Show, we must know the following. I
Yes or No
                    plan to participate in the State 4-H Horse Show if I earn enough points to qualify.
Yes or No           I understand that no horse will be allowed to stall until approved by State Agricultural Inspector.
                    I hereby acknowledge receipt of the Florida 4-H Area & State Horse Shows Official Rules 2011 or have accessed it
Yes or No           at, http://www.animal.ufl.edu/Youth/horse/showRules.shtml (hereafter referred to as the Area & State Rule Book).
                    I understand that the rules stated in the Area and State Rule Book will be strictly enforced at the 20 11 Area and State
Yes or No
                    4-H Horse Shows.
                    I acknowledge that I am responsible for understanding the rules stated in the Area and State Rule Book and agree to
Yes or No
                    comply with the rules.
                    I understand that failure to comply with the rules stated in the Area and State Rule Book may result in disciplinary
Yes or No
                    action or disqualification.
                    I understand that any bit that I use at the Area and State shows must meet the requirements in the Rule Book “as is”.
Yes or No
                    I understand that unacceptable bits will NOT be able to be wrapped or otherwise altered to make them acceptable
Yes or No           I authorize the verification of the information provided on this form
                    STATEMENT OF UNDERSTANDING
                    In consideration of myself having been accepted by the Cooperative Extension Service to attend a 4-H activity, I
                    hereby hold harmless and release the host facility, Florida 4-H Club Foundation, Florida Cooperative Extension
                    Service, its employees and the volunteer 4-H leader(s) from any financial responsibility for an y and all injuries,
                    including death. I also give my permission for him/her to be treated in case of medical emergency while attending a
                    4-H event. To insure prompt attention in case of serious sickness or accident, I hereby authorize the person
                    responsible to incur expense considered necessary and I agree to pay for same, if this is not covered by an accident
                    and sickness insurance policy.
                        The Florida 4-H Programs and IFAS pro vide knowledgeable staff who are concerned with the 4-H'ers safety and
                    well being. I know and understand that horses can be unpredictable, especially when frightened, injured or exposed
Yes or No
                    to something new and that they can rear, kick, throw, bite, and cause other injuries. I understand the necessity for
                    safety practices and rules to do everything reasonable to prevent injury to child or horse and that insurance is
                    available to me to cover reasonable costs of injury. I understand that in spite of all that is done to provide for well -
                    being, there is always a certain risk involved in participation. I UNDERSTAND THAT UNDER FLORIDA L AW, AN
                    EQUINE ACTIVITY SPONSOR OR PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO, OR THE DEATH OF, A
                    PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.
                        I further agree to assume responsibility for damage or injury to the child, his/her horse or equipment or that
                    caused by the child or horse while participating in the Program. I, also, give consent for my son/daughter to be under
                    the disciplinary control of the official chaperons(s) designated by Florida Cooperative Extension Service. I ha ve read
                    the above and understand the risks involved.
                    CONTESTANT: This is my completed form for participation in the Area 4-H Horse Show of the State of Florida. I will
                    conduct myself in a sportsmanlike manner, abide by the Florida 4-H Code of Conduct and the rules of the show, and
Yes or No           accept the decision of the judges as final. I have carefully checked the name and number of classes entere d and
                    upon arrival at check-in at the Area show will review my entries to assure that I am in the proper division. I
                    understand classes may be deleted, but no classes may be added, and no class changes will be allowed.
                    I understand that if 3 people from my county do not help to clean up after the show on Saturday I will be assessed a
Yes or No
                    fee of up to $50.00.
SPECIAL NOTE ON INSURANCE COVERAGE: Individuals participating in the Area and State 4-H Horse Show will be covered by insurance. The
benefit limits will be as follows: Accident coverage $2500, Dental coverage (repair to sound natural teeth only ) $350, Loss o f Life $2000, Illness $1000.

Exhibitor’s Signature:                                                                               Type Exhibitor’s Name:

                                                                                                     Type Parent / Guardian Name:
Parent / Guardian Signature:
Yes or No           LEADER: I have read the official rules of the Florida State Horse Shows and hereby certify to the eligibility of the
                    above named contestant to age, eligibility of horse and completion of requirements for competition. I have reviewed
                    the classes entered, and it is my belief that these classes are correct as relates to age and ability.

                                                                                                     Type 4-H Leader’s Name:
4-H Leader’s Signature:
Yes or No           COUNTY AGENT: I have read the official rules of the Florida State Horse Shows and hereby certify to the eligibility
                    of the above named contestant to age, eligibility of horse and completion of requirements for competition. I have
                    reviewed the classes entered, and it is my belief that these classes are correct as relates to age and ability.

                                                                                                     Date:
Extension Agent Signature:
Type Extension Agent Name:                                                                           County: Choose One

                                         2011 Area B 4-H Horse Show Registration Form 2 of 3
      Classes for the 2011 Area B Horse Show are as follows :



      See entry rules for the numbers of classes a participant may register in …


             Western Divi sion                                                                     Hunter Divi sion
1.    Stock Type Mares, 14.2 hands and under                                     28.   Hunter   Type Mares, 14.2 hands and under
2.    Stock Type Geldings, 14.2 hands and under                                  29.   Hunter   Type Geldings, 14.2 hands and under
3.    Stock Type Mares, over 14.2 hands                                          30.   Hunter   Type Mares, over 14.2 hands
4.    Stock Type Geldings, over 14.2 hands                                       31.   Hunter   Type Geldings, over 14.2 hands

5.    Jr./Int. Western Showmanship, 13 and under                                 32.   Jr./Int. Hunter Showmanship, 13 and under
6.    Sr. Western Showmanship, 14 and over                                       33.   Sr. Hunter Showmanship, 14 and over

7.    Western Pleasure Pony, 14.2 hands and under                                34.   Pony Hunter Under Saddle, 14.2 hands and under
8.    Jr./Int. Western Pleasure, over 14.2 hands                                 35.   Jr./Int. Hunter Under Saddle, over 14.2 hands
9.    Sr. Western Pleasure, over 14.2 hands                                      36.   Sr. Hunter Under Saddle, over 14.2 hands
                                                                                 37.   Jr./Int. Hunt Seat Equitation, 13 and under
10. Jr./Int. Western Horsemanship, 13 and under                                  38.   Sr. Hunt Seat Equitation, 14 and over
11. Sr. Western Horsemanship, 14 and over                                        39.   Jr./Int. Hunter Hack, 13 & under
                                                                                 40.   Sr. Hunter Hack, 14 & over
12.   Western Riding                                                             41.   Pony Working Hunter, 14.2 hands and under
13.   Reining                                                                    42.   Working Hunter, over 14.2 hands, no ponies
14.   Jr./Int. Western Trail, 13 and under                                       43.   Jr./Int. Equitation over Fences, 13 and under
15.   Sr. Western Trail, 14 and over                                             44.   Sr. Equitation over Fences, 14 and over
16.   Ranch Riding                                                               45.   Handy Hunter
17.   Ranch Versatility Trail                                                    46.   Jr./Int. Dressage, 13 & under
                                                                                 47.   Sr. Dressage, 14 & over
                 Saddle/Gaited Division
18. Saddle Type & Gaited Mares                                                                   Speed Events Divi sion
19. Saddle Type & Gaited Geldings
                                                                                 48.   Jr./Int. Pole Bending, 13 and under
20. Jr./Int. Saddle Type & Gaited Showmanship, 13 and under                      49.   Sr. Pole Bending, 14 and over
21. Sr. Saddle Type & Gaited Showmanship, 14 and over                            50.   Jr./Int. Barrel Race, 13 and under
                                                                                 51.   Sr. Barrel Race, 14 and over
22.   Saddle Seat Pleasure, trotting                                             52.   Jr./Int. Keyhole Race, 13 and under
23.   Gaited Pleasure, non-trotting                                              53.   Sr. Keyhole Race, 14 and over
24.   Saddle Seat Equitation, trotting                                           54.   Jr./Int. Stake Race, 13 and under
25.   Gaited Equitation, non-trotting                                            55.   Sr. Stake Race, 14 and over
26.   Road Hack, trotting
27.   Gaited Performance, non-trotting




                                         2011 Area B 4-H Horse Show Registration Form 3 of 3

				
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