Dear 4-H Horse Project Member

June 29, 2016

Dear 4-H Horse Project Member,

Enclosed you will find the registration form for the HarfordCounty 4-H Horse Clinic and other important information regarding the clinic. The clinic will be held at the Harford County Equestrian Center, 608 North Tollgate Road, Bel Air, MD 21014 onAUGUST 15-17 (three days, two nights).

The enclosed forms (registration, release & informed consent, volunteer, concussion & cardiac arrest forms) need to be completed and returned along with a negative coggins and health form by JULY 22

to:

HarfordCounty 4-H Office

P.O. Box 663

Forest Hill, MD21050

Registration fees should be made payable to: HARFORD COUNTY EAC.

The fee is $140 per individual child and $100 for each additional youth in the immediate family if payment and forms are turned in by July 22. After July 22the cost will be $165 per child(No refunds).Completed applications include Registration Form,Adult Volunteer Form,

4-H’er/Chaperone Assignment Form,Parental Release& Informed Consent Form, Maryland

4-H Behavioral Form,Current Negative Coggins and a Health Form, Concussion and Sudden Cardiac Awareness forms. Applications will be accepted on a first come basis as space permits. ALL forms and payment, with required signatures and dates, need to be received prior to the event. Equine self-evaluation forms will be submitted when you bring your horse/pony.

Those 4-H’ers enrolled in the “Horseless” program may also attend the clinic during the day but not overnight. They may participate in any activities except the actual riding instruction. “Horseless”

4-H’ers must be accompanied by their parent or a designated UME volunteer. There will be a charge of $25 per day to attend the activities and join us for lunch and dinner. Fill out the top of the form and circle “Horseless” and return it along with your registration fee.

Space is limited, therefore it is important that you return your application and fee as soon as possible. If you have any further questions or concerns, please call Kathy at the 4-H Office 410-638-3255.

*All forms including the 4-H Health Statement forms are available online at our county website they can be picked up at the Extension Office. Please sign and date all forms and initial the Cardiac Arrest form for submission with your registration and payment. (If you attended 4-H Camp at the Rocks, we already have your health form.) Don’t forget to include a current negative coggins for your pony/horse.If you are in need of a scholarship, call the 4-H Office.

*All 4-H’ers must register on-site before unloading or setting-up sleeping area (the main pavilion). Registration and arrival time will be Sunday, August 14 from 6:00 – 8:00 p.m. (horses only) and Monday, August 15from 6:30 – 8:30 a.m. The registrar must have all completed forms before you begin unloading.

*4-H’ers WILL NOT spend the night Sunday evening, but animals and all necessary equipment may be brought in. Someone will be spending the evening with the horses.

*There will be an orientation meeting for all 4-H’ers, chaperones and volunteers on Monday,August 15 at 9:00 a.m. on the bleachers closest to the barns.

Parents: Your support is greatly appreciated. For the benefit of all participants: Parents or guardians may visit your child during the clinic and siblings should only accompany you if you are visiting for a very short time (dropping something off, picking something up) and they must remain with you at all times. Please be sure to get a name tag and fill in the sign in/out sheet located by the kitchen. The clinic is open to family members on Wednesday during the horse show or gymkhana and again any siblings must remain with you supervisedat all times. Dogs are not permitted. All volunteers should be pre-registered on the Volunteer Form.

Sincerely,

Cynthia L. Warner

Extension Educator, 4-H

HarfordCounty

Enclosures

“If you need special assistance to participate in the Horse Clinic, please contact the Extension Office at 410-638-3255 two weeks prior to the event.

“Equal Opportunity and Equal Access Programs”

PAID ______

COGGINS TEST ______

HEALTH FORM ______

RELEASE, CONSENT & BEHAVIORAL FORM______

CONCUSSION & CARDIAC ARREST FORM ______

HARFORDCOUNTY 4-H HORSE CLINIC

REGISTRATION FORM2016

AUGUST 15, 16 & 17

EquestrianCenter, Tollgate Road in Bel Air

Cost: $140 ($100 for each additional youth in immediate family) if all forms and payment are received by July 22. ***$165 per child after July 22

Name Club ______

Full address ______

4-H Age ______Phone ______Email ______

Circle: English WesternDo you take riding lessons? Yes______No______

Horseless If yes, how long? ______

Instructor’s name Phone ______

Do you consider yourself a: Beginner Intermediate Advanced ______

How long have you been riding? On flat Jumping How high? ______

Do you ride: Show Pleasure Do you trail ride your horse? ______

What is your horse’s experience? Large group Small group _____

Horse’s name ______

Age Sex Height (hands) ______

Is it: Green ______Experienced ______Does it jump? ______

How long have you been riding this horse? ______

Veterinarian’s name Phone ______

Farrier’s name Phone ______

Does your horse have any vices, special needs or require special care? Explain:

______

(Continued on other side)

SUGGESTED ACTIVITIES & CLINICS

(Check top ten choices)

Equine Careers Fitting & Showing Vaulting

Line Dancing Jousting Massage

Polo Crosse Gymkhana Driving

Acupuncture Saddle Fitting Dentist

Crafts Dirty Pony Contest Videos

Western Riding Tack Cleaning Party Horse Show

Horse Bowl & Judging Levels Testing Dressage Clinic

_____ Campfire & Skits Roping

Trip to

Do you have other suggestions? ______

Horsemanship Standards Levels 1 & 2 Knowledge & Riding will be offered at Horse Clinic for both English & Western. This is mandatory to show at the county & state fairs. Please circle if you need this testing.

YES NO

Testing for Horsemanship Standards Level 3 English - Knowledge, Riding & Jumping & Western -Knowledge & Riding (level 3 riding is mandatory to show at the county & state fair) will be offered during the clinic. Please circle if you need this testing.

YES NO

YES NO

T-shirt size (circle one) Not sure that we will have funds for this. If anyone knows of a business or person to sponsor this, please let us know.

youth medium youth large

adult small adult medium adult large adult x large

ADULT VOLUNTEER FORM

In order to make the Horse Clinic a success, we depend on UME adult volunteers to help. To chaperone a group of

4-H’ers, you must be a UME trained volunteer. We are asking that each family volunteer some time to help at the clinic. During the clinic, help is needed in the kitchen (cook, set-up, clean-up, etc.), assist the instructors with equipment, set-up jumps – take down jumps, someone to stay overnight in the barn and much, much more. If you are unable to actually be at the clinic, there are preparation tasks that need your support. If you need the UME Volunteer training, contact the 4-H Office immediately.

Please indicate below how you will be able to assist us in providing your child with a wonderful experience.

Volunteer Name: ______Phone: ______

Club: ______Are you a UME chaperone for your group? ______

Will you be staying full-time? ______If so, for how many nights? ______

Kitchen help (we must have several volunteers so that meals will run on time and smoothly). Breakfast is served at 8:00, lunch12:00 & dinner 6:00. You will need to arrive at least a half hour before meals.

We need everyone’s help to make this clinic successful and safe for everyone. If everyone contributes in some way it makes it easier for everyone. Please consider carefully how you can help.

Sunday Times available ______to ______

Monday Times available ______to ______

Tuesday Times available ______to ______

Wednesday Times available ______to ______

We really need help on Sundayevening with setting up jumps (someone with a truck and hitch to pull the wagon) and removing tables from the sleeping area and on Wednesday with putting away jumps, putting tables back in sleeping area and general clean up (sweeping floors, emptying trash cans, etc.).

Adults unavailable at the clinic but available for other preparation activities:

______

Specify if you have a particular interest:

______

If you are an EMT, nurse or doctor and will be on site, please let us know the times. ______

There will be an orientation meeting for all chaperones, volunteers and 4-H’ers on Monday, August 15 at9:00 a.m. on the bleachers nearest to the barns.

If you have questions or need additional information, contact Cynthia Warner or Kathy Porcella at the Harford County Extension Office at (410) 638-3255.

Thank you for your support!

4-H’ER/CHAPERONE ASSIGNMENT

4-Her’s Name: ______

Each participant must have a chaperone (one per every 8 campers). Please list below the name and phone number of the person who will be serving as your chaperone. Your chaperone must also sign this form before it is returned.

Name: Phone: ______

Check one: UME trained volunteer 4-Her’s parent

Chaperone’s signature: ______



TACK STALLS

Horse stalls and tack/feed stalls will not be pre-assigned. You may select and set up your stalls when you arrive. Stalls are encouraged to be decorated with any theme of your choice. You may include pictures, curtains, name, breed or any other information you would like to provide.

Stall cards will be provided for each horse with the horse’s name, vet name and phone number, farrier name and phone number, and your name. Please be sure to complete these items on your registration form. There is a line for “Special Instructions” that you can complete when you arrive (if needed).

WHAT TO BRING TO THE HORSE CLINIC

Listed below are items that will make your stay more enjoyable. Remember, you must have all the equipment needed to care for your horse, set-up a tack stall and sleep area. This list is a guide - you may want to make additions or deletions.

Sleep space:Riding Equipment:For Setting Up Your Stalls

extension cordhelmet(horse & tack):

fanriding pants & shirtbuckets – 2 (water & feed)

laundry bagriding bootshammer

broomhooks for tack

trash bagsaddle rack

paper towelsmuck bucket

rake

Bedding:For Your Horse:pitch fork

cot/folding lawn chair/air mattresscoggins testhose (only a few needed)

sheetssalt/electrolytesscrewdriver

sleeping baggrooming equipmentbucket hooks

pillowbeddingnails & screws

feedscrew eyes

Wash Items:haydouble snaps

towels (2-3)fly spray

washclothbreak-away halter-no substitution

foot covering to wear in shower

Toiletries:Tack:Extras:

soapEverything you need toflashlight (extra batteries)

shampooride your horse:plastic bags (for wet items)

toothbrush/toothpastesaddlesnacks in closeable containers

kleenexgirthcooler

insect repellentbridlesmiles

sunblock/suntan lotionsaddle pad

Clothes:

shorts

tops – with sleeves

jeans

sweatshirt or light jacket

pajamas

tennis shoes

waterproof shoes

raincoat

2016HARFORD COUNTY 4-H HORSE CLINIC RULES

 Clinic check-in time will be Sunday, August 14, 6:00-8:00 p.m.(horses only) and Monday, August 15, 6:30-8:30 a.m.

 Signed, completed Health, Volunteer, Chaperone, Release & Informed Consent,Concussion and Cardiac Arrest Awareness forms, current negative Coggins Test and payment must have been received by the Extension Office by July22 for the lower rate. ALL paperwork MUST be turned in prior to the event, except Equine Self Evaluation.

 All clinic rules apply upon arrival.

 Your chaperone must be verified and approved by committee for you to unload and remain at the clinic. Remember: Only UME trained volunteers may serve as chaperones for a group (8 youth).

 No bare feet or sandals allowed in barns or around horses (only in the pavilion).

 No riding allowed at any time without proper apparel (shoes with heels, 4-H approved hard hats – ASTM/SEI), t-shirts with sleeves and riding pants preferred, chaps permitted with long pants – no shorts. Riding permitted only during lessons.

 You are not allowed in the horse barn area after dark.

Do not leave the sleeping area after dark.

The general public is not invited-families of participants only.

 Only registered participants and approved chaperones (UME trained volunteers) are allowed to spend the night.

 Only clinic participants are allowed on the horse/pony that they registered to bring.

 No riding allowed after the final lessons of the day, unless otherwise specified.

• You can only ride during the scheduled time with

your group & instructor.

• You may not switch horses or ride anyone else’s

horse/pony – No exceptions.

 Parents are welcome as spectators only (unless they

have volunteered to help) and must wear a name tag.

 Parents are requested not to interfere with the planned program or with the instructor’s placement of riders.

 4-H’ers are to do their own work. More experienced 4-H members will offer assistance to younger members when needed.

 No switching of stalls (tack or horse) once they are set up.

 No horse may be put in any stall other than their own, even temporarily. Keep all stall doors closed.

 Tack will be kept in tack stalls, not in aisle ways.

 The times for preparation for bed, quiet time and lights out will be strictly enforced. At 10:00 p.m. lights will be out and you are expected to be in bed and quiet. Everyone needs proper rest.

 All electronics and flashlights must be turned off by 10:00 p.m. or they will be taken by the chaperone and returned at the end of the clinic.

 All stalls (horse and tack) and sleeping areas must be cleaned before release time on Friday.

 Stalls will be inspected after your horse is loaded.

 All horses must be out by 3:00 p.m. on WEDNESDAY,AUGUST 17 . The committee must be contacted if you are unable to check-out on time.

 ALL 4-H’ers will participate in all scheduled events unless prior arrangements are made with the clinic committee.

• Think before doing, if you have any doubt about something, don’t do it, check with someone in charge.

PROGRAM: Harford County 4-H Horse Clinic DATE(S): August (14-set up only) 15,16,17

My minor child, as listed below, has my permission to fully participate as a representative of the Maryland Cooperative Extension (MCE) Maryland 4-H Youth Development Program in all activities associated with the above named program.

In connection with and consideration of my child’s participation in the Program, I, on behalf of my child and myself, my heirs, personal representative(s) and assigns, hereby represent and agree as follows:

1.I am aware that any program related activity can be dangerous, and I fully recognize and understand that there are risks

and hazards, both minor and serious, associated with participation in the Program and related activities, including, but

not limited to: cuts, scrapes, bruises, broken bones, muscle strains, pulls or tears, head, neck, back, eye and other bodily injuries, heat prostration, brain damage, blindness, deafness, drowning, heart attacks, paralysis and, even, death. The following is a description and examples of specific, significant, non-obvious dangers and risks associated with this

activity. There is potential for accidents and/or injuries arising from:

a.riding horsese. camp fire

b.caring for horsesf. water games

c.using horse equipment and suppliesg. other horses, all horses–kicks, bites, stepped on, falls, drug, etc.

d. horse facilitiesh. other campers, persons

2.I understand that my child is not in any way required to participate in the Program, but I want them to participate, despite the possible dangers and despite this Release.

3.I represent and warrant that my child has no physical, health related or other problems which would preclude or restrict their participation in the Program or otherwise render their participation dangerous or harmful to them or others. I further represent and warrant that my child has adequate medical, health and/or other insurance for participation.

4.Knowing the dangers, hazards and risks associated with the Program, and with sufficient knowledge of my child’s

physical condition(s) and limitations, if any, I voluntarily assume all responsibility and risk of loss, damage, illness

and/or injury to person or property which my child may, in any way, sustain in connection with participation in the

Program and related activities.

5.I agree that my child must abide by all rules and regulations applicable to participation in the Program. Should my child require emergency medical treatment or first aid as a result illness or injury associated with the Program or related activities, I consent to such first aid and/or treatment.

6.To the fullest extent permitted by law, I hereby release and forever discharge, and agree not to sue and to indemnify and hold harmless, the State of Maryland, the University of Maryland, Maryland Cooperative Extension and their governing boards, officers, agents, employees and volunteers from and against any and all liabilities, claims, demands and causes of action of any kind on account of any loss, damage, illness or injury to person or property in any way arising out of or relating to my child’s participation in the Program and/or related activities, whether due to the negligence, mistake or other action or inaction of MCE or any other person or entity.

I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER AND THAT I HAVE READ AND FULLY UNDERSTAND THIS RELEASE AND INFORMED CONSENT FORM, AND I SIGN IT VOLUNTARILY WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Signature of Parent/Guardian Having Care and Custody of Participating ChildDate

Name of Parent/Guardian: Emergency Telephone:

Participating Child’s Name:Signature:Age: