North Carolina East Qualifying 4-H Horse Show Registration Packet - April 29 - May 1, 2022

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North Carolina East Qualifying 4-H Horse Show Registration Packet - April 29 - May 1, 2022
North Carolina
   East Qualifying 4-H Horse Show

          Registration Packet

     Hosted by the Northeast & Southeast
             4-H Horse Councils
Senator Bob Martin Eastern Agricultural Center
             Williamston, NC

           April 29 – May 1, 2022
North Carolina East Qualifying 4-H Horse Show Registration Packet - April 29 - May 1, 2022
2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

    IMPORTANT SHOW INFORMATION AND CHECKLIST
                    ALL ENTRIES MUST BE PRE-ENTERED, NO POST ENTRIES
    Please Read Carefully. Please be sure to include your email address on the Entry form. Horse show
        information and updates will be sent out only via email. One Horse/Rider Per Entry Form.
                                             MAIL ENTRIES TO:
                            **YOUR COUNTY EXTENSION OFFICE between March 17-March 31.**

                    *ENTRIES WILL ONLY BE ACCEPTED TO YOUR COUNTY EXTENSION OFFICE
                                 BETWEEN MARCH 17 AND MARCH 31, 2022.

                      *Extension Staff will mail entries to the Washington County Office by April 8th.
All Extension Staff mailing packets with a postmark after April 8th will be charged a LATE FEE of $30.00 per entry*
                     NO ENTRIES WILL BE ACCEPTED AFTER a postmark date of April 14th.

  **You will NOT be able to add classes at the show. Please sign up for All Classes you intend to show at the time you register!
                                 This is in keeping with the State 4-H Horse Show Policy.**
                      *No Refunds will be given out without an MD and/or DVM note after April 20!

                                                        Pony Measurement
          Measurement staff must measure all ponies in Junior, Senior, and Western pony classes, as well as youth showing a
                                 pony and horse in gaming classes before packet will be released.

                                                Coggins
               COGGINS WILL BE CHECKED WHILE ON SHOWGROUNDS AND COPY MUST BE POSTED
                             ON STALL DOOR. (Must present paper copy at check in!)

                                                        Eligibility Cards:
                      Must be completed and signed by EXTENSION AGENT for every horse/rider combination.
                                        Only submit a COPY, you must keep your original.

                                                       Cloverbud Registration
                 To avoid confusion on class fees and numbers, Cloverbud youth now have a separate registration form.

                                                                Dressage
                  Dressage ride times will be assigned. If you have any class conflicts with your time, please go to the
                      paddock master before your ride time and let them know so you can get a different time.
                               If you miss your ride time, you will NOT be assigned a new ride time!

Important Reminders:
        ➢ All riders must wear an ASTM approved helmet when mounted.
        ➢ No cell phone use when mounted.
        ➢ All western riders must show with two numbers displayed on each side of their saddle pad.
        ➢ Class 2 will run open card for all fence heights. Please notify the gate steward at the beginning of your division if your
            completing a warmup round.
        ➢ Other COVID-19 consideration will be made in compliance with the CDC. https://www.cdc.gov/coronavirus/2019-
            ncov/animals/events-animal-activities.html

East Qualifying 4-H Horse Show Exhibitor Checklist:
   ➢ Entry Form, completed and signed since no changes are to be made at the show
   ➢ Copy of Eligibility Card sent in with show entries
   ➢ Copy of 4-H Medical Release Form sent in with show entries (request a copy from your agent)
   ➢ Signed copy of Notices and Waivers that are included in this packet
   ➢ Check made payable to: NED 4-H Horse Council

                                                                                                                                       2
2022 East Qualifying 4-H Horse Show April 29-May 1, 2022
1.   Neither the North Carolina Cooperative Extension Service, Northeast District 4-H, Southeast District 4-H, or show hosts will be
     responsible for an accident that may occur to any animal, person, or property at this show. The exhibitors and spectators shall
     hold the management or owners or grounds as a hold harmless and indemnify it against any legal proceeding arising from any
     accident that might occur.
2.   The judges’ decision shall be final. When an exhibitor or exhibitor’s parents, leader, or agent is guilty of unsportsmanlike
     conduct, the show management may suspend such exhibitor’s rights to participate in future classes and/or shows for such a period
     of time as judged appropriate.
3.   Rules from the North Carolina 4-H Horse Program Rules and Regulations Manual will be followed. USEF, AQHA, AMHR,
     USDF, WDAA, and WHOA rules will be followed for their respective divisions not covered in the NC 4-H Horse Program Rules
     and Regulations Manual.
4.   Show management reserves the right to (a) combine, cancel or split classes depending on the number of entries and (b) disqualify
     from showing any horse or pony that is unmanageable, dangerous, or unsound and any youth who exhibits unsportsmanlike or
     inappropriate behavior.
5.   Exhibitors will not be allowed to add classes at the show.
6.   Short Stirrup: Riders must be ages 8-13 as of January 1st of the current year. Three years’ participation in the division is
     allowed, with no more than 2 years’ showing over fences. (Hunter Hack does not count towards the 2 years over fences and may
     be shown all 3 years.
7.   Rookie: Riders in their first year of showing Hunt Seat as a Junior or Senior as of January 1st of the current year. Riders are
     permitted 1 year to show as this level.
8.   Long Stirrup: Riders must be ages 14-18 as of January 1st of the current year. Two years of participation in the division is
     allowed. Riders in this division may not have previously shown over fences for more than 2 years.
9.   Little Britches: Riders must be ages 8-13 as of January 1st of the current year, who are in their first 2 years of showing. Riders
     in this division cannot cross enter in the Junior Western or Junior Ranch Divisions.
10. Junior Riders: Youth who have not reached the age of 14 as of January 1st of the current year.
11. Senior Riders: Youth who have reached the age of 14 as of January 1st of the current year and have not reached the age of 19
    as of January 1st of the current year.
12. Open Warmup Classes are non-qualifying classes for warm up over fences at 2’, 2’3”, and 2’6” – These classes may be
    used for Combined Training Qualification, but ring steward must be told in advance. Proceeds from entries in these classes
    support the Billy S. Murray Memorial Scholarship Fund of the SED4HHC
13. Billy Murray (BM) Classes are non-qualifying classes for warm up and practice purposes – Not open to Cloverbuds.
    Proceeds from entries in these classes support the Billy S. Murray Memorial Scholarship Fund of the SED4HHC.
14. Qualifying Points: The following point system will be used in earning qualifying points toward attending the State 4-H Horse
    Show. Each exhibitor and horse must earn one or more qualifying point in each division to be eligible to participate in that
    division in the State Show. The number of horses in a class will be determined by the number shown. Under no circumstances
    shall a disqualified contestant receive points; however, each horse brought into the ring will constitute an entry and will be
    counted.
           Number of Horses in Class                Class Placing and Points
                                                    1      2       3      4       5       6      7       8      9       10
           1                                        1
           2                                        2       1
           3                                        3       2      1
           4                                        4       3      2       1
           5                                        5       4      3       2      1
           6 to 12                                  6       5      4       3      2       1
           13 to 15                                 7       6      5       4      3       2      1
           16 to 17                                 8       7      6       5      4       3      2       1
           18 to 19                                 9       8      7       6      5       4      3       2      1
           20 or more                               10      9      8       7      6       5      4       3      2       1

                                                                                                                                          3
2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

           "STYLE in the AISLE"
                        Announcing the East Qualifying 4-H
                              Stall Decorating Contest
            ALL AFFILIATES WILL BE AUTOMATICALLY ENTERED FOR JUDGING
                                 BY CLUB OR COUNTY

                        PRIZES TO THE TOP 5 CLUB/COUNTY WINNERS
RULES AND REGULATIONS

  1. All contestants need to sign up Friday at the Registration D e s k .
  2. Stall decorations are based on craftsmanship, originality/creativity and maintenance throughout the entire
     affiliate's club stall area.
  3. All stalls within the affiliate's area will be judged on cleanliness.
  4. Stalls must be ready to be judged by Saturday morning at 10:00 a.m. Decorations must remain in place
     until noon on Saturday.
  5. Points will be awarded as follows:
          a. 40% on maintenance and cleanliness
          b. 30% on originality/creativity
          c. 30% on craftsmanship
  6. Teams may use curtains. However, farm or stable curtain/decorations will not be eligible. Club or county
     name should be clearly posted on each stall to be judged for groups.
  7. No decorations may be placed outside the barns.

                                                                                                                  4
2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

                      SATURDAY, April 30, 2022 - 7:30AM - MAIN ARENA                                                         SATURDAY, April 30, 2022 - 8:30 AM - COVERED ARENA
      1   Rookie Hunter Hack Crossrails^^                                                                  37   BM Non-Trotting/Saddle Seat Jr/Sr Rider 2-Gait No Canter (Non-Qualifying)
      2   BM Open Warm Up 2' O/F (Non-Qualifying)/Combined Training Qualification                          38   Jr/Sr Rider Non-Trotting Equitation 2-Gait (English/Western)
      3   Short Stirrup Working Hunter Over Fences                                                         39   Jr/Sr Rider Saddle Seat Equitation*
      4   Short Stirrup Hunt Seat Equitation Over Fences                                                   40   Jr/Sr Rider Non-Trotting Pleasure 2-Gait (English/Western)
      5   Short Stirrup Hunter Hack^^                                                                      41   Jr/Sr Rider Non-Trotting Pleasure 3-Gait (English/Western)
      6   Jr Rider Pony Working Hunter Over Fences                                                         42   Jr/Sr Saddle Seat Pleasure*
      7   Sr Rider Pony Working Hunter Over Fences                                                                                                           15 minute Break
      8   Jr Rider Pony Hunt Seat Equitation Over Fences                                                   43   Cloverbud Showmanship Western Tack & Attire (Non-Qualifying)
      9   Sr Rider Pony Hunt Seat Equitation Over Fences                                                   44   Little Britches Showanship
     10   Jr Rider Pony Hunter Hack^^                                                                      45   Jr/Sr Rider Non-Trotting Showmanship
     11   Sr Rider Pony Hunter Hack^^                                                                      46   Jr/Sr Rider Saddle Seat Showmanship*
     12   Sr Long Stirrup Working Hunter Over Fences Horse/Pony                                            47   Jr/Sr Rider Pony Western Showmanship
     13   Sr Long Stirrup Hunt Seat Equitation Over Fences Horse/Pony                                      48   Jr Rider Horse Western Showmanship
     14   Sr Long Stirrup Hunter Hack Horse/Pony^^                                                         49   Sr Rider Horse Western Showmanship
     15   BM Open Warm Up 2'3" O/F (Non-Qualifying)/Combined Training Qualification                             Nancy Gates Memorial Award Presented to Winner
     16   Low Working Hunter Over Fences Jr/Sr Horse                                                       50   Cloverbud Western Horsemanship (Non-Qualifying)
     17   Low Hunt Seat Equitation Over Fences Jr/Sr Horse                                                 51   Cloverbud Western Pleasure Walk/Jog (Non-Qualifying)
     18   BM Open Warm Up 2'6" O/F (Non-Qualifying)/Combined Training Qualification                        52   Jr Rider Ranch Pleasure
     19   Working Hunter Over Fences Jr/Sr Horse                                                           53   Sr Rider Ranch Pleasure
     20   Hunt Seat Equitation Over Fences Jr/Sr Horse                                                     54   Jr Rider Ranch Riding
          Annie Moore Memorial Award Presented to Winner                                                   55   Sr Rider Ranch Riding
     21   Jr Rider Horse Hunter Hack^^                                                                     56   Jr Rider Ranch Horsemanship
     22   Sr Rider Horse Hunter Hack^^                                                                     57   Sr Rider Ranch Horsemanship
                                                Break (Drag Arena)                                         58   Jr Rider Ranch Reining
          Gaming Division -- Will not begin before 5pm                                                     59   Sr Rider Ranch Reining
     23   Cloverbud Barrel Race (Canter not allowed/Non-Qualifying)                                                                                        Break (Drag Arena)
     24   BM Open Barrel (Non-Qualifying)                                                                  60   Adaptive Rider Showmanship - Open/All Levels**
     25   Jr Rider Barrel Race                                                                             61   Adaptive Rider Walk, Assisted/Unassisted - Level 1**
     26   Sr Rider Barrel Race                                                                             62   Adaptive Rider W/T, Assisted/Unassisted - Level 1**
     27   Cloverbud Texas Barrels (Canter not allowed/Non-Qualifying)                                      63   Adaptive   Rider   EQ W/T, Assisted/Unassisted - Level 1**
     28   BM Open Texas Barrels (Non-Qualifying)                                                           64   Adaptive   Rider   Walk, Assisted/Unassisted - Level 2**
     29   Jr Rider Texas Barrels                                                                           65   Adaptive   Rider   W/T, Assisted/Unassisted - Level 2**
     30   Sr Rider Texas Barrels                                                                           66   Adaptive   Rider   EQ W/T, Assisted/Unassisted - Level 2**
     31   Jr Rider Flag Race                                                                               67   Adaptive   Rider   Walk, Unassisted - Level 3**
     32   Sr Rider Flag Race                                                                               68   Adaptive   Rider   W/T, Unassisted - Level 3**
     33   Jr Rider Pole Bending                                                                            69   Adaptive   Rider   EQ W/T, Unassisted - Level 3**
     34   Sr Rider Pole Bending
     35   Jr Rider Stake Race                                                                                               SATURDAY, April 30, 2022 - 9:00 AM - OUTDOOR ARENAS
     36   Sr Rider Stake Race                                                                                                           (Locations to be Determined)
                                                                                                                Times will be posted in advance for each test.
                                         Minimum/Maximum Fence Heights                                     70   Western Dressage Basic Test 2 Open- Test 2022
                 Rookie Hunter Hack Crossrails                           18" X-Rails                       71   Western Dressage Intro Test 2 Open- Test 2022
                                                                                                           72   Intro Level Test B Open- Test 2019
                 Pony & Short/Long Stirrup                               2'
                                                                                                           73   Intro Level Test C Open- Test 2019
                 Jr/Sr Horse                                             2'3"                              74   Training Level Test 1 Open – Test 2019
                 Working Hunter Horse (Jr/Sr Riders)                     2' 6" - 2' 9"                     75   Training Level Test 3 Open- Test 2019
                                                                                                           76   Cloverbuds Intro Level Test A - Test 2019 or Western Intro Level Test 2 - Test 2022
                 Low Working Hunter (Jr/Sr Riders)                       2' 3"
                                                                                                                Classes below will begin after conclusion of Class 62
                 Long Stirrup (Horses & Ponies)                          2'                                77   Jr Rider Ranch Ground Handling
                 Short Stirrup (Horses & Ponies)                         2'                                78   Sr Rider Ranch Ground Handling
                                                                                                           79   BM Jr/Sr Rider Horse/Pony Trail (Non-Qualifying)
                 Large Ponies (Jr/Sr)                                    2' 3" – 2' 6"
                                                                                                           80   Cloverbud Trail (Non-Qualifying)
                 Medium Ponies (Jr/Sr)                                   2' – 2' 3"
                                                                                                           81   Little Britches Trail (Walk/Jog)
                 Small Ponies (Jr/Sr)                                    2'                                82   Jr Rider Western Horse Trail
                                                                                                           83   Sr Rider Western Horse Trail
                                                                                                           84   Jr/Sr Rider Western Pony Trail
                                                                                                           85   Jr Rider Ranch Trail Horse/Pony
                                                                                                           86   Sr Rider Ranch Trail Horse/Pony

^         A horse (or pony) rider combo cannot cross enter between Low Over Fences and Working Hunter and Equitation Over Fences classes.
^^        Hunter Hack jumps first with call back for rail work.
          BM/Open Warmup - Non-Qualifing/Proceeds from entries in these classes support the Billy S. Murray Memorial Scholarship Fund of the SED4HHC.
*         The Saddle Seat Division has been eliminated at the NC State 4-H Horse Show.
**        To be eligible for Adaptive Rider classes, exhibitors must meet the requirements in the NC 4-H Horse Program Rules & Regulations.

                                                                                                                                                                                                      5
2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

              SUNDAY, May 1, 2022 - 7:30 AM - MAIN ARENA                                   SUNDAY, May 1, 2022 - 15 minutes after conclusion of class 90 - COVERED ARENA
  87   Cloverbud Showmanship English Tack & Attire (Non-Qualifying)                         117   BM Short Stirrup/Rookie Walk/Trot (Non-Qualifying)
  88   Rookie Hunter Showmanship                                                            118   Rookie Hunter Under Saddle Walk/Trot
  89   Short Stirrup Showmanship                                                            119   Rookie Hunt Seat Equitation Walk/Trot
  90   Jr/Sr Rider Horse/Pony Stock Type Hunter Showmanship                                 120   Short Stirrup Hunter Under Saddle
  91   Sr Rider Pony Hunt Seat Showmanship                                                  121   Short Stirrup Hunt Seat Equitation on the Flat
  92   Jr Rider Pony Hunt Seat Showmanship                                                  122   Short Stirrup Bridle Path Hack
  93   Sr Rider Long Stirrup Showmanship                                                    123   BM Open Jr/Sr Hunter Pony Walk/Trot (Non-Qualifying)
  94   Jr Rider Horse Hunt Seat Showmanship                                                 124   Sr Rider Pony Hunter Under Saddle
  95   Sr Rider Horse Hunt Seat Showmanship                                                 125   Jr Rider Pony Hunter Under Saddle
                                      Break (Drag Arena)                                    126   Sr Rider Pony Hunt Seat Equitation on the Flat
  96   BM Open Jr/Sr Stock Type Hunter Walk/Trot (Non-Qualifying)                           127   Jr Rider Pony Hunt Seat Equitation on the Flat
  97   Jr/Sr Rider Stock Type Hunter Under Saddle^^^                                        128   Sr Rider Pony Bridle Path Hack
  98   Jr/Sr Rider Stock Type Hunter Equitation on the Flat^^^                              129   Jr Rider Pony Bridle Path Hack
  99   Jr/Sr Rider Stock Type Hunter Show Hack^^^                                           130   BM Open Sr Long Stirrup Hunter Horse/Pony Walk/Trot (Non-Qualifying)
 100   Cloverbud Equitation English Tack & Attire (Non-Qualifying)                          131   Sr Long Stirrup Hunter Under Saddle Horse/Pony
 101   Cloverbud Pleasure EnglishTack & Attire W/T/2-Gait (Non-Qualifying)                  132   Sr Long Stirrup Hunt Seat Equitation on the Flat Horse/Pony
 102   BM Open Jr/Little Britches Horse Western Rider Walk/Jog (Non-Qualifying)             133   Sr Long Stirrup Bridle Path Hack Horse/Pony
 103   BM Open Sr Western Rider Horse Walk/Jog (Non-Qualifying)                             134   BM Open Jr Rider Hunter Horse Walk/Trot (Non-Qualifying)
 104   BM Open Jr/Sr Western Rider Pony Walk/Jog (Non-Qualifying)                           135   Jr Rider Horse Hunter Under Saddle
 105   Little Britches Western Pleasure (Walk/Jog)                                          136   Jr Rider Horse Hunt Seat Equitation on the Flat
 106   Jr Rider Horse Western Pleasure                                                      137   Jr Rider Pony Bridle Path Hack
 107   Sr Rider Horse Western Pleasure                                                      138   BM Sr Rider Hunter Horse Walk/Trot (Non-Qualifying)
 108   Jr/Sr Rider Pony Western Pleasure                                                    139   Sr Rider Horse Hunter Under Saddle
 109   Little Britches Western Pleasure (Walk/Jog/Lope)                                     140   Sr Rider Horse Hunt Seat Equitation on the Flat
 110   Jr/Sr Rider Western Pleasure Jr Horse/Pony (5 & Under)                               141   Sr Rider Horse Bridle Path Hack
 111   Jr/Sr Rider Western Pleasure Sr Horse/Pony (6 & Up)
 112   Little Britches Western Horsemanship (Walk/Jog)
 113   Jr Rider Horse Western Horsemanship
 114   Sr Rider Horse Western Horsemanship
 115   Jr/Sr Rider Pony Western Horsemanship
 116   Jr/Sr Rider Horse/Pony Western Riding

^^^    A horse (or pony) rider combo cannot cross enter between Stock Type Hunter Division and any other Hunter Division/Classes.

                                                                                                                                                                           6
2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

            Please: Only One Horse and One Exhibitor Per Form!                                                                           Exhibitor Name:

4-H County/Club:

                                                                                                                                         Exhibitor Date of Birth (mm/dd/year):
Leader Name:                                                                                                                                                                             Exhibitor’s Mailing Address & Phone # -
                                                                                                                                         Address:__________________________________________________________________
Leader Email/Phone:
                                                                                                                                         City, State & Zip:____________________________________________________________

Horse Name (Must Match Coggins):
                                                                                                                                         Phone Number:______________________________________________________________
                                                                                                                                         Email Address: (required for show updates)________________________________________
                                                                                                   Classes By Division (Circle the ones you are entering.)
             Rookie                                      Short Stirrup                                 Long Stirrup                            Jr Rider Pony Hunt Seat                        Sr Rider Pony Hunt Seat         Jr Rider Horse Hunt Seat
          1 88 118 119                                    3 4 5 89                                    12 13 14 93                                    6 8 10 92                                      7 9 11 91                     16 or 19, 17 or 20
                                                         120 121 122                                  131 132 133                                   125 127 129                                    124 126 128                   21 94 135 136 137
   Sr Rider Horse Hunt Seat           Jr/Sr Rider Non-Trotting               Jr/Sr Rider Saddle Seat                                                 Little Britches                           Jr Rider Horse Western         Sr Rider Horse Western
        16 or 19, 17 or 20                 38 40 41 45                              39 42 46                                                      44 81 105 109 112                                   48 82 106                     49 83 107
      22 95 139 140 141                                                                                                                                                                         110* or 111*, 113 116          110* or 111*, 114 116
   Jr/Sr Rider Pony Western           Jr/Sr Stock Type Hunter                    Jr Rider Ranch                                                      Sr Rider Ranch                                Jr Rider Gaming               Sr Rider Gaming
   47 84 109 110* or 111*                  90 97 98 99                              52 54 56                                                           53 55 57                                   25 29 31 33 35                26 30 32 34 36
             115 116                                                                58 77 85                                                           59 78 86
            Dressage*              BM Warm Up O/F*/Combined Training               Billy Murray*                                                                                    *Denotes Non-Qualifying Classes
    70 71 72 73 74 75                         2 15 18                      24 28 37 79 96 102 103
                           Adaptive Rider                                  104 117 123 130 134 138                                         There will be No Entries or                    Use “Stall Reservation Form”       Entries Must be in Your
                                                                                                                                         Changes Accepted the day of the                  to reserve stall, shavings, and
           60 61 62 63 64 65 66 67 68 69                                                                                                                                                                                      County Agent’s Hands
                                                                                                                                                      show!                                        RV Hookups.
  The following items MUST be included with your entry form for it to be considered complete:                                                                                                                               Between March 17-31, 2022
     1.     Check Payable to “NED 4-H Horse Council”                                                                                   NOTE: NO OPEN CHECKS ACCEPTED                                                          Quantity      Total Cost
     2.     Show Entry Form Signed by Exhibitor (if 18 older), otherwise by parent or legal guardian.                                  Total Entries @ $10.00/class:
     3.     Copy of 2022 4-H Medical Release (Provided by Agent)
     4.     Copy of 2022 NC 4-H Horse Eligibility Card (Completed & Signed) (NO ORIGINALS)                                             Total Entries @ $5.00/class (BM and Warm-up):
     5.     Copy of AHSA (USAE) Permanent Pony Card (if Applicable) (NO ORIGINALS)                                                     Administrative & EMT Fees ($5.00 each):                                                                $10.00
     6.     Copy of Notice and Wavier Forms (Last page of Registration Packet)
                                                                                                                                       Late Fee $30.00 (Entries Post Marked after March 31, 2022)
     7.     Copy (Paper Only) of Coggins – Required at check in and must be produced upon request.
                                                                                                                                       No refunds after April 20, 2022 without written note from MD or DVM                   Total Amt.:
*This event or activity is operation under the 4-H code of Conduct & Disciplinary Procedure. The NC 4-H Code of Conduct & Disciplinary Procedure (https://nc4h.ces.ncsu.edu/wp-
content/uploads/2016/01/4-H_codeofconduct.pdf?fwd=no) is a condition of participation in 4-H events & activities.” “Under North Carolina Law, an equine activity sponsor or equine
professional is not liable for and injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina
General Statutes”
Signature (exhibitor if 18 or older, otherwise parent or legal guardian):

                                                                                                                                                                                                                                                         7
2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

                                                                                                                                         Please: Only One Horse and One Exhibitor per form!
Cloverbud Registration Form (5-7 years old as of January 1, 2022)                                                                        Exhibitor Name:

 4-H County/Club:

                                                                                                                                         Exhibitor Date of Birth (mm/dd/year):
 Leader Name:                                                                                                                                                                            Exhibitor’s Mailing Address & Phone # -
                                                                                                                                         Address:_________________________________________________________________
 Leader Email/Phone:
                                                                                                                                         City, State & Zip:___________________________________________________________
 Horse Name (Must Match Coggins):
                                                                                                                                         Phone Number:____________________________________________

                                                                                                                                         Email Address: (required for show updates)______________________________________
                                                                                                   Classes By Division (Circle the ones you are entering.)
                Cloverbud English Division Attire & Tack                                                                  Cloverbud Dressage                                                            Cloverbud Western Division Attire & Tack
                                                                                                 Intro Level Test A (2019) or Western Intro Level Test 2 (2022)
                                   87 100 101                                                                                  76                                                                                     43 50 51

                       Cloverbud Gaming (walk/trot)                                                                    Cloverbud Trail (walk/trot)

                                 Barrel Race – 23                                                                                      80

                               Texas Barrels -- 27                                                                                                                                                                             Entries Must be in Your
                                                                                                                                           There will be No Entries or                    Use “Stall Reservation Form”          County Agent’s Hands
                                                                                                                                         Changes Accepted the day of the                  to reserve stall, shavings, and     Between March 17-31, 2022
  The following items MUST be included with your entry form for it to be considered complete:                                                         show!                                        RV Hookups.

     1.     Check Payable to “NED 4-H Horse Council”                                                                                   NOTE: NO OPEN CHECKS ACCEPTED                                                            Quantity      Total Cost
     2.     Show Entry Form Signed by Exhibitor (if 18 older), otherwise by parent or legal guardian.                                  Total Entries @ No Cost/class:                                                                               ----
     3.     Copy of 2022 4-H Medical Release (Provided by Agent)
     4.     Copy of 2022 NC 4-H Horse Eligibility Card (Completed & Signed) (NO ORIGINALS)                                             Administrative Fee:                                                                                         $5.00
     5.     Copy of AHSA (USAE) Permanent Pony Card (if Applicable) (NO ORIGINALS)                                                     EMT Fee:                                                                                                    $5.00
     6.     Copy of Notice and Wavier Forms (Last page of Registration Packet)
                                                                                                                                       Late Fee $30.00 (Entries Post Marked after March 31, 2022)
     7.     Copy (Paper Only) of Coggins – Required at check in and must be produced upon request.
                                                                                                                                       No refunds after April 20, 2022 without written note from MD or DVM                     Total Amt.:
*This event or activity is operation under the 4-H code of Conduct & Disciplinary Procedure. The NC 4-H Code of Conduct & Disciplinary Procedure (https://nc4h.ces.ncsu.edu/wp-
content/uploads/2016/01/4-H_codeofconduct.pdf?fwd=no) is a condition of participation in 4-H events & activities.” “Under North Carolina Law, an equine activity sponsor or equine
professional is not liable for and injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina
General Statutes”

Signature (exhibitor if 18 or older, otherwise parent or legal guardian):

                                                                                                                                                                                                                                                           8
2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

                                         STALL RESERVATION FORM
               Questions about stalls? Contact: Beth Stanley Jackson                     Email: beth_jackson@ncsu.edu

         •    Coggins will be checked at the barn by an individual designated by the show committee and must be
              posted outside horse’s stall for inspection by the state vet. Fines for violations will be passed on to the
              exhibitor.
         •    Stall fee covers both Friday and Saturday nights. There is not a different rate for a one-night stay.
         •    Counties and Clubs will be grouped together as much as possible.
         •    NO REFUNDS on stall and/or RV reservations after April 20, 2022, without written note from MD or DVM.
         •    The facility requires a minimum purchase of 2 bags of shavings per stall. These 2 bags of shavings are
              included in the price of the stall and will be provide for you. There are no refunds on pre-ordered shavings.
         •    Extra savings will be available at the show groups during the show and must be paid for at the show
              office. Outside shavings are not permitted per facility rules.
         •    Stall Size Approximately 10x10. Wash stalls are available at facility.
         •    Stall check-in available starting at 12 noon on Friday, April 29th,, and will be open as long as the show
              office is open each day of the show.

Exhibitor Name:

Phone Number:                                        Email: _

Horse Name (Must Match Coggins):

4-H Club to Stall with:                                                           County to Stall with:

Arrival Day:                                                        Approximate Arrival Time:

                                                                         Cost              Number Needed                   Total
  Stalls – Equine (includes 2 bags of shavings)                        $55.00
  Tack Stalls (includes 2 bags of shavings)                            $55.00
  Extra Shavings                                                     $6.50 / bag
  RV Parking                                                        $30.00 each
                                                                       night
                                                                                        GRAND TOTAL

Stall reservation MUST be included with Registration Form and in your County Agent’s hands between March 17-31, 2022.
                                 Checks should be payable to the “NED 4-H Horse Council”.

 Sign below and return with payment to your COUNTY AGENT:
 Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant
 in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General
 Statutes”
 Signature (exhibitor if 18 or older, otherwise parent or legal guardian):
 Office Use Only:   Paid Amt:                    Check #                        Cash
 Barn                                            Stall Assignment_____________ __________

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2022 East Qualifying 4-H Horse Show April 29-May 1, 2022
                                                 NOTICES and WAIVERS
                                                              WARNING
   Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury or death of a participant in
    equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General
                                                                Statutes.

       NORTH CAROLINA 4-H YOUTH DEVELOPMENT PROGRAM LIABILITY WAIVER,
    ASSUMPTION OF THE RISK, PHOTO & MEDIA RELEASE, AND INDENIFICATION YOUTH
                                  AGREEMENT
In consideration of NC State University and/or NC A&T State University allowing my minor child to participate in the North Carolina
4-H Program, (hereinafter “Program”), I, for myself and/or on behalf of the minor child listed below (“Minor”), agree as follows:

I affirm and acknowledge that the Minor is participating in the Program for their own personal benefit. I understand that the Minor will
participate in recreational and other activities as part of the Program and that such activities have inherent dangers and physical risks. I
understand and acknowledge that the inherent dangers and physical risks involved in these activities are such that no amount of care,
caution, instruction or expertise can completely eliminate them. These dangers and risks include, but are not limited to, loss of or
damage to personal property, strains, sprains, bruises, heat exhaustion, and other personal injuries, or even death, that could result from
tripping, falling, contact with other individuals, and equipment failure, among other causes. I assume responsibility for all risks, known
and unknown, involving the Minor’s participation in the aforementioned activities, and I voluntarily authorize the Minor’s participation
in reliance upon my own judgment and knowledge of the Minor’s experience and capabilities.

Additionally, I understand that the coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health
Organization and has become more widespread, including within North Carolina. COVID-19 is very contagious and believed to be
spread mainly from person-to-person contact. I understand and appreciate that there are known and potential dangers of utilizing the
Program’s facilities, services and programs, and I acknowledge that the use of these facilities and services may, despite the Program’s
reasonable efforts to mitigate the dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious
illness, disability and/or death. The Center for Disease Control and state and local health departments, are reviewing and updating their
respective guidance on the pandemic and its impact nearly every day.

I represent that I am acting on my behalf or as the parent or legal guardian of the Minor and I have authority to enter this Agreement. I
also represent that the Minor is in proper physical and other condition to participate in the Program. I understand that it is my sole
responsibility to determine whether the Minor is sufficiently fit and healthy enough to participate in the Program, and if necessary, I
will consult with the Minor’s physician for appropriate guidance. On behalf of myself and the Minor, I hereby agree to indemnify and
hold harmless NC Cooperative Extension, NC State University, NC A&T State University, the NC 4-H Youth Development Program,
and their trustees, officers, directors, employees and agents (the “Released Parties”) from any liability, losses, costs, damages, claims
or causes of action of any kind or nature whatsoever, and expenses, including attorneys’ fees, arising from, resulting from, or relating
in any way to the Minor’s participation in the Program. I further agree that if, despite this Agreement, the Minor or anyone on the
Minor’s behalf, makes a claim against any of the Released Parties, I will indemnify, defend and hold harmless each of the Released
Parties from any liabilities which may be incurred as a result of such claim.

I understand that the Minor and I are required to be familiar with and abide by the Program’s rules and regulations, including the 4-H
Code of Conduct and/or the NC 4-H Volunteer Standard of Behavior and any safety regulations established for the benefit of all
participants. I accept sole responsibility for the conduct and actions of the Minor while they are participating in the Program. I
understand that this is a legal document which is binding on me, my heirs and assigns and on those who may claim by or through me. I
am eighteen years of age or older, and have full capacity to enter into this agreement and do so voluntarily.

_____YES, I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

 Signature of Parent/Guardian:                                                       Date: _________________________________

 Printed Name: _________________________________                 Printed Name of Child:     ________________________________

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2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

                                    North Carolina 4-H Photo & Media Release

I agree to allow NC Cooperative Extension, the 4-H Youth Development Program, NC State University, and/or NC A&T
State University or their agents to photograph or record the Minor during the Program. I further agree that the Minor’s
image or likeness in photographs, videos, or audio may be used for educational or promotional purposes, including
broadcasting or posting on the Internet. I agree that the use described herein may be without compensation to me or the
Minor. On behalf of myself and the Minor, I waive any right to inspect or approve the finished electronic, photograph, or
printed matter that may be used in conjunction with the printed matter now or in the future. I expressly release NC
Cooperative Extension, North Carolina 4-H Youth Development, NC State University, NC A&T State University, their
agents, employees, licensees and assigns from any and all claims which I or the Minor may have for invasion of privacy,
right of publicity, defamation, copyright infringement, or any other causes of action arising out of the use, adaptation,
reproduction, distribution, broadcast or exhibition of such recordings.

Check one:
_____ I agree to photo/media use for any use described herein.
_____ I do not agree to photo/media use for any use described herein.

I understand that this is a legal document which is binding on me, my heirs and assigns and on those who may claim by or
through me. I am eighteen years of age or older, and have full capacity to enter into this agreement and do so voluntarily.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.
 Signature of Parent/Guardian:                                             Date: _________________________________

 Printed Name: _________________________________          Printed Name of Child:   ________________________________

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2022 East Qualifying 4-H Horse Show April 29-May 1, 2022
                       North Carolina 4-H Code of Conduct and Disciplinary Procedure

The NC 4-H Youth Development Program has established standards of conduct for all participants. It is the responsibility
of the parent/legal guardian and the participant to review the Code of Conduct and Disciplinary Procedures.

        I. Purpose and Application:
               A.      The 4-H Code of Conduct is intended to foster safe face-to-face and online environments that are
                       conducive to optimal learning and growth. Toward that end, youth participants are expected to
                       behave in a way that respects the dignity, rights, and property of others, and that will not disrupt or
                       interfere with 4-H program goals.

                B.      This 4-H Code of Conduct and Disciplinary Procedure is a condition of participation in any North
                        Carolina 4-H activities or programs.

        II. Behaviors Prohibited at 4-H Program Activities:
                A.     Possession, selling, and/or use of alcoholic beverages, tobacco products, and illegal drugs OR
                       being present where individuals are using alcohol, tobacco products and/or any illegal substances
                B.     Any kind of sexually related physical contact
                C.     Bullying, harassing our using derogatory language towards another person or group of people is
                       prohibited
                D.     Harassment will not be tolerated. Hazing is prohibited. Cyberbullying is prohibited
                E.     Recording, taking, sharing screenshots or images is prohibited unless directed to do so for
                       Program purposes
                F.     Sharing links or passwords for Programs or content is prohibited unless directed to do so for
                       Program purposes
                G.     Possession of weapons or firearms (except while participating in a 4-H Shooting Sports Event)
                H.     Behavior that violates state or local laws
                I.     Damage to property of others
                J.     Theft, misuse or abuse of public or personal property
                K.     Conduct that jeopardizes the safety of self or others
                L.     Conduct that disrupts or interferes with 4-H programming
                M.     Using Program content, contacts, images or video for personal use outside the scope of the
                       Program
                N.     Sharing personal information, email, or social media accounts with individuals outside the scope
                       of the Program
                O.     Leaving a program or facility without permission of parents or 4-H staff (including authorized
                       volunteers)
                P.     Inappropriate dress, including but not limited to clothing that is disruptive to the operations or
                       goals of 4-H. Examples may include, but are not limited to, clothing with negative or hateful
                       language or symbols and shirts or pants that fail to appropriately fit or to cover a participant’s
                       body and undergarments. Clothing should meet the standards expected in public schools. Specific
                       clothing requirements may be implemented where appropriate for a particular event.

        III. Additional Basis for Disciplinary Action
                County or State Extension personnel may impose discipline pursuant to Part IV below in cases of
                misconduct by current, former, or prospective 4-H participants if, in the judgment of 4-H personnel or
                their supervisors, the misconduct poses a potential risk to the 4-H program. This includes risks to the
                safety or well-being of others and risks to the effective functioning or integrity of 4-H. This applies
                regardless of whether the misconduct occurred during a 4-H activity or in a setting unrelated to 4-H
                activity.

        IV. Disciplinary Procedures:
                A.     Discipline may be imposed by any 4-H staff or Cooperative Extension Service employee who has
                       oversight responsibility for 4-H activities.

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2022 East Qualifying 4-H Horse Show April 29-May 1, 2022
               B.       Unless immediate action is required, the following procedures should take place before imposing
                        any adverse consequences:
                        1)      the accused participant shall be told the charge (which of the prohibited behaviors listed
                                above he or she is accused of violating), and
                        2)      the accused participant is told what factual evidence supports the charge, and
                        3)      the accused participant has been given a chance to tell his/her side of the story.

               C.       The 4-H staff person must be satisfied that the participant engaged in the prohibited behavior
                        before imposing a sanction.

               D.       Sanctions may include some or all of the following:
                        1)      Verbal warning
                        2)      Notification to parents
                        3)      Immediate removal from the activity
                        4)      Being placed on a behavior contract
                        5)      Referral to local law enforcement and/or juvenile court
                        6)      Program suspension and/or
                        7)      Expulsion from program
                        8)      Dismissed participants may not be eligible for a refund of any fees or expenses
                        9)      Other sanctions appropriate to the circumstances, as determined by 4-H.

               E. Appeals
                      1)        Disciplinary action for local or county-level events may be appealed to the County
                                Director and or 4-H Agent. All appeals must in writing and must be received by the
                                County Director and or 4-H Agent within 30 days of the disciplinary action. The County
                                Director and or 4-H Agent or designee shall review the appeal statement, any written
                                response from the decision maker, and may review other relevant information. The
                                County Director and or 4-H Agent shall send a written decision to the appellant, the 4-H
                                staff member who made the initial decision, and Head of the State 4-H Youth
                                Development Program. The County Director and or 4-H Agent’s appeal decision shall
                                constitute the final agency action unless the Head of the State 4-H Youth Development
                                Program chooses to exercise further review.
                        2)      Disciplinary action for regional or state-level events may be appealed to the Head of the
                                State 4-H Youth Development Program, Cooperative Extension Service, Box 7655, NC
                                State University, Raleigh NC 27695-7655; telephone (919) 513-3059. All appeals must in
                                writing and must be received by the Head within 30 days of the disciplinary action. The
                                State 4-H Youth Development Program Head or designee shall review the appeal
                                statement, any written response from the decision maker, and may review other relevant
                                information. The Head shall send a written decision to the appellant and the 4-H staff
                                member who made the initial decision, and the Head’s appeal decision shall constitute the
                                final agency action.

               F.       Immediate action situations: 4-H or Extension staff may take immediate action to remove a
                        participant from an activity and other action as needed, where there is an emergency situation or
                        significant risk of continuing misconduct. In those cases, the immediate action is temporary
                        discipline and the 4-H or Extension staff must arrange for the procedures in parts B, C, D, and E
                        above as soon as possible but in no event longer than seven days from the temporary discipline.

Member Print Name:___________________________________________            Member Signature: ___________________________

Signature of Parent/Guardian:                                             Date: _____________________________________

Printed Name: __________________________________          Printed Name of Child: _________________________________

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2022 East Qualifying 4-H Horse Show April 29-May 1, 2022

                           AGENT CHECKLIST
        □ Entry Form(s) (Only One Horse and One Exhibitor Per Form!)
           *completed and signed since no changes are to be made at the show*
        □ Copy of Eligibility Card(s)
        □ Copy of 4-H Medical Release Form
        □ Signed copy of Notices and Waivers
        □ Check made payable to: NED 4-H Horse Council
        □ Vendor Application (optional)

                    MAIL OR DELIVER PACKETS TO:
                  Washington County Cooperative Extension
                         c/o Beth Stanley Jackson
                            128 E. Water Street
                           Plymouth, NC 27962

Registration Questions:
Beth Stanley Jackson, 4-H Agent (Washington County)
beth_jackson@ncsu.edu (252)793-2163

Contact Information for Horse Specific Questions:
Tom Harrell, 4-H Program Assistant (Currituck County)
tom_harrell@ncsu.edu (252)232-2261

Jessica Manning, 4-H Agent (Wilson County)
jessica_manning@ncsu.edu (252)237-0111

Eileen Coite, Agriculture Agent (Sampson County)
eileen_coite@ncsu.edu (910)592-7161

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