Arena & Obstacle Course

Arena & Obstacle Course

4-H Registration Packet

North St. Louis & Itasca County 4-H

Please check Clinic you will be attending:

• 3-day Clinic 12 June 23, 24 and 25 2018.

If you have taken this clinic before it is recommendedto take it again don’t be fooled you will learn something new every time.

(Nonrefundable/Nontransferable) or $400.00 3-day Paid in Full Clinic

• 2-day Clinic 3 September 15 & 16 2018.

(Nonrefundable/Nontransferable) 250.00 2-day Paid in Full Clinic

Clinic Descriptions are on our website:

Check with us for Clinic Availability.

Limited amount of participants.

Email:

Cell: 1-218-244-2328

Please send all Registration Forms & Payments to:

4-H Office

Registration Form

Print and mail in registration. (Please print clearly.)

Name: ______Age:____

Street Address: ______

City: ______State: ______Zip: ______

Phone: ______

PRINT CLEARLY

Email:

Horse Name: ______Age:______

Due to a limited number of participants please check with us for clinic availability by

calling (218) 244-2328, or by email .

Indicate below the clinic(s) you are attending.

Total Enclosed: $______Balance Due: $______

Method of Payment:

• Cash Amount: $______

In person payments only. Do not mail cash.

• Check Number: #______Amount of Check: $______
• Credit Card Number: # ______

Exp. Date: ______CVC: ______Zip Code: ______

*Please note arena address is different than mailing.

Arena address: Lee Rd Deer River MN 56636

Stall Deposit

We provide each horse an outdoor stall free of charge for our clinic participants. However, we do require a $20.00 stall deposit.

Please sign below to acknowledge you understand the stall deposit policy, and that the deposit will be returned to you at the end of the clinic if your stall and the area around your stall are undamaged, cleaned, and inspected.

Signature: ______

I have enclosed check #: ______(separate check) for the $20.00 stall deposit.

You will need to provide your own:

Water Bucket (we supply water)

Hay

Hay Nets or Bags

(Hay nets with holes > 1 3/4" are not allowed. Hay nets and bags with holes =/< 1 3/4" are acceptable.)

Feed

Feed Pans

Shavings (if you would like shaving in your stall.)

We supply manure carts, wagons, racks, forks, and etc.

We do ask that when you are finished with your stall that the stall and the area around your stall is free of any manure, hay and garbage.

Thank you for helping us keep H&H clean!

Release and Waiver of Liability Agreement

I, ______(Participant), have engaged the services of Michelle Jerry to provide assistance with the training of my horse. I acknowledge that no guaranteed results has been made regarding the outcome of the training and understand there can be none. I also acknowledge and understand that I will be directly involved in the process of training the animal and I AM AWARE THAT THESE ACTIVITIES ARE HAZARDOUS ACTIVITIES AND THAT I OR MY HORSE COULD BE SERIOUSLY INJURED. I AM VOLUNTATILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWEDGE OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS ARE OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN.

I verify this statement by placing my initials here: ______

In addition, I forever release Michelle Jerry and Francis Jerry from any and all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (I) my participation in these activities,(I) the negligence or other acts, whether directly connected to these activities or not, and however caused, or (I) the condition of the premises where these activities occur, whether or not I am participating in the activities. I also agree that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of Michelle Jerry and Francis Jerry in connection with any of the matters covered by foregoing release.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF, MICHELLE JERRY AND FRANCIS JERRY, COUNTY OF ITASCA, STATE OF MINNESOTA, AND SIGN IT OF MY OWN FREE WILL.

Executed at Heart and Hooves Horsemanship Deer River MN 56636 on ______20___.

PARTICIPANT or GUARDIAN SIGNATURE: ______ADDRESS: ______

______PHONE: ( ) ______

Heart & Hooves Horsemanship Arena & Obstacle Course RULES

The following rules are in place for your safety and the safety of others:

1. Horse must be at least 2 years of age to attend a clinics.

2. No Stallions allowed.

3. No Pets (NO EXCEPTIONS)

4. Hay nets with holes > 1 3/4" are not allowed. Hay nets and bags with holes =/< 1 3/4" are acceptable.

5. You must be 6th grade older to attend clinic.

6. Children must be supervised at all times. THIS IS NOT A PLAYGROUND!

7. Only Clinic participants will be allowed in the Arena or Obstacle Course during a clinic.

8. Auditing: $30 for the 2 day Clinic. All auditors will be required to stay in the designated area.

9. No consumption of alcohol before, or during any horse related activity. Examples of horse related activities are clinic, trail ride, riding, obstacle course, groundwork, etc.

10. PLEASE PICKUP AFTER YOURSELF AND YOUR HORSE!!!

Please sign below to acknowledge you understand and are willing to comply with the above rules.

Thank you, Francis and Michelle Jerry.

Signature: ______

What to Bring to the Clinic

Clinic 1

Horse:

Rope halter 14 foot lead rope (no chains)

Horseman’s stick with removable string

Equine leg protection (sport boots, or polo wraps)

(Not required but, recommended)

Participants:

Drinking water

(You will need to provide your own drinking water during the clinic)

Sunscreen

Gloves

Clinic 2, 3 & 4

Saddle

Saddle blanket or pad

Bridle (snaffle bit recommended)

Riding boots with a heel

Heart & Hooves General Store

Rope halters, lead ropes, and horseman’s sticks with a removable strings, gloves and sports boots are available

On-site for purchase.

Clinic Daily Schedules are provided on our website:

Please retain this page for your record.