Official Registration Packet - Beaufort County Center
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2021 East Qualifying 4-H Horse Show April 30-May 2, 2021
Official
Registration Packet
North Carolina
East Qualifying 4-H Youth Horse Show
Hosted by the Northeast & Southeast
4-H Horse Councils
Senator Bob Martin Eastern Agricultural Center
Williamston, NC
1
2021 East Qualifying 4-H Horse Show April 30-May 2, 2021
IMPORTANT SHOW INFORMATION
AND CHECKLIST
ALL ENTRIES MUST BE PRE-ENTERED, NO POST ENTRIES
Guidelines:
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 AGENT between March 17-March 31.**
*ENTRIES WILL ONLY BE ACCEPTED TO YOUR COUNTY EXTENSION OFFICE
BETWEEN MARCH 17 AND MARCH 31, 2021.
*County Extension Agents will mail entries to the Wilson County Extension office by April 9, 2021,
OR they will incur a $30.00 LATE FEE*
NO ENTRIES WILL BE ACCEPTED AFTER a postmark date from your Extension Office of
April 16th.
**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 19!
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 to send to State show if you Qualify.
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.
Important Reminders:
➢ All riders must wear an ASTM approved helmet when mounted.
➢ All western riders must show with two numbers displayed on each side of their saddle pad.
➢ Masks must be worn by participants and spectators at all times unless mounted on a horse. Masks must also be worn for
in-hand classes. If you have a medical exemption for wearing a mask, please include that in your entry form packet.
➢ The show rings will be video recorded and livestreamed per the NC Youth Livestock/Horse Show Guidelines.
➢ 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 Show 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: SED 4-H Horse Council
2
2021 East Qualifying 4-H Horse Show April 30-May 2, 2021
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. 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.
13. 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
32021 East Qualifying 4-H Horse Show April 30-May 2, 2021
"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 in Friday at the
Registration Des 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. First through fifth place will be
announced on Saturday.
8. No decorations may be placed outside the barns.
9. Get creative and have a wonderful time!
42021 Official East Qualifying 4-H Horse Show April 30-May 2, 2021
SATURDAY, May 1, 2021 - 7:30AM - MAIN ARENA SATURDAY, May 1, 2021 - 8:30 AM - COVERED ARENA
1 Rookie Hunter Hack^^ 34 BM Non-Trotting/Saddle Seat Jr/Sr Rider 2-Gait No Canter (Non-Qualifying)
2 Open Warm Up 2' O/F (Non-Qualifying)/Combined Training Qualification 35 Jr/Sr Rider Non-Trotting Equitation 2-Gait (English/Western)
3 Short Stirrup Working Hunter Over Fences 36 Jr/Sr Rider Saddle Seat Equitation
4 Short Stirrup Hunt Seat Equitation Over Fences 37 Jr/Sr Rider Non-Trotting Pleasure 2-Gait (English/Western)
5 Short Stirrup Hunter Hack^^ 38 Jr/Sr Rider Non-Trotting Pleasure 3-Gait (English/Western)
6 Jr Rider Pony Working Hunter Over Fences 39 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 40 Cloverbud Showmanship Western Tack & Attire (Non-Qualifying)
9 Sr Rider Pony Hunt Seat Equitation Over Fences 41 Little Britches Showmanship
10 Jr Rider Pony Hunter Hack^^ 42 Jr/Sr Rider Non-Trotting Showmanship
11 Sr Rider Pony Hunter Hack^^ 43 Jr/Sr Rider Saddle Seat Showmanship
12 Sr Long Stirrup Hunter Hack Horse/Pony 44 Jr/Sr Rider Pony Western Showmanship
13 Sr. Long Stirrup Hunt Seat Equitation Over Fences Horse/Pony 45 Jr Rider Horse Western Showmanship
14 Sr Long Stirrup Hunter Hack Horse/Pony^^ 46 Sr Rider Horse Western Showmanship
15 Low Working Hunter Over Fences Jr/Sr Horse Nancy Gates Memorial Award Presented to Winner
16 Low Hunt Seat Equitation Over Fences Jr/Sr Horse 47 Cloverbud Western Horsemanship (Non-Qualifying)
17 Working Hunter Over Fences Jr/Sr Horse 48 Cloverbud Western Pleasure Walk/Jog (Non-Qualifying)
18 Hunt Seat Equitation Over Fences Jr/Sr Horse 49 Jr Rider Ranch Pleasure
Annie Moore Memorial Award Presented to Winner 50 Sr Rider Ranch Pleasure
19 Jr Rider Horse Hunter Hack^^ 51 Jr Rider Ranch Riding
20 Sr Rider Horse Hunter Hack^^ 52 Sr Rider Ranch Riding
Break (Drag Arena) 53 Jr Rider Ranch Western Horsemanship
Gaming Division -- Will not begin before 5 pm 54 Sr Rider Ranch Western Horsemanship
21 BM Open Barrel (Non-Qualifying) 55 Jr Rider Ranch Reining
22 Cloverbud Barrel Race (Canter not allowed/Non-Qualifying) 56 Sr Rider Ranch Reining
23 Jr Rider Barrel Race
24 Sr Rider Barrel Race
25 BM Open Texas Barrels (Non-Qualifying)
26 Jr Rider Texas Barrels SATURDAY, May 2, 2021 - 9:00 AM - OUTDOOR ARENAS
27 Sr Rider Texas Barrels (Locations to be Determined)
28 Jr Rider Pole Bending Times will be posted in advance for each test.
29 Sr Rider Pole Bending 57 Western Dressage Basic Test 2 Open- Test TBD
30 Jr Rider Stake Race 58 Western Dressage Intro Test 2 Open- Test TBD
31 Sr Rider Stake Race 59 Intro Level Test B Open- Test TBD
32 Jr Rider Flag Race 60 Intro Level Test C Open- Test TBD
33 Sr Rider Flag Race 61 Training Level Test 1 Open – Test TBD
62 Training Level Test 3 Open- Test TBD
Minimum/Maximum Fence Heights 63 Cloverbuds Intro Level Test B- Test TBD
Classes below will begin after conclusion of Class 56
2' 6" - 2' 9"
64 Jr Rider Ranch Ground Handling
65 Sr Rider Ranch Ground Handling
66 BM Jr/Sr Rider Horse/Pony Trail (Non-Qualifying)
67 Cloverbud Trail (Non-Qualifying)
Short Stirrup (Horses & Ponies)
68 Little Britches Trail (Walk/Jog)
Large Ponies (Jr/Sr) 2' 2" – 2' 6" 69 Jr Rider Western Horse Trail
Medium Ponies (Jr/Sr) 2' – 2' 3" 70 Sr Rider Western Horse Trail
71 Jr/Sr Rider Western Pony Trail
Small Ponies (Jr/Sr)
72 Jr Rider Ranch Trail Horse/Pony
73 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.
52021 Official East Qualifying 4-H Horse Show April 30-May 2, 2021
SUNDAY, May 2, 2021 - 7:30 AM - MAIN ARENA SUNDAY, May 2, 2021 - 15 minutes after conclusion of class 80 - COVERED ARENA
74 Cloverbud Showmanship English Tack & Attire (Non-Qualifying)
75 Rookie Hunter Showmanship 104 BM Short Stirrup/Rookie Walk/Trot (Non-Qualifying)
76 Short Stirrup Showmanship 105 Rookie Hunter Under Saddle Walk/Trot
77 Jr/Sr Rider Horse/Pony Stock Type Hunter Showmanship 106 Rookie Hunt Seat Equitation Walk/Trot
78 Sr Rider Pony Hunt Seat Showmanship 107 Short Stirrup Hunter Under Saddle
79 Jr Rider Pony Hunt Seat Showmanship 108 Short Stirrup Hunt Seat Equitation on the Flat
80 Sr Rider Long Stirrup Showmanship 109 Short Stirrup Bridle Path Hack
81 Jr Rider Horse Hunt Seat Showmanship 110 BM Open Jr/Sr Hunter Pony Walk/Trot (Non-Qualifying)
82 Sr Rider Horse Hunt Seat Showmanship 111 Sr Rider Pony Hunter Under Saddle
Break (Drag Arena) 112 Jr Rider Pony Hunter Under Saddle
83 BM Open Jr/Sr Stock Type Hunter Walk/Trot (Non-Qualifying) 113 Sr Rider Pony Hunt Seat Equitation on the Flat
84 Jr/Sr Rider Stock Type Hunter Under Saddle^^^ 114 Jr Rider Pony Hunt Seat Equitation on the Flat
85 Jr/Sr Rider Stock Type Hunter Equitation on the Flat^^^ 115 Sr Rider Pony Bridle Path Hack
86 Jr/Sr Rider Stock Type Hunter Show Hack^^^ 116 Jr Rider Pony Bridle Path Hack
87 Cloverbud Equitation English Tack & Attire (Non-Qualifying) 117 BM Open Sr Long Stirrup Hunter HorsePony Walk/Trot (Non-Qualifying)
88 Cloverbud Pleasure EnglishTack & Attire W/T/2-Gait (Non-Qualifying) 118 Sr Long Stirrup Hunter Under Saddle Horse/Pony
89 BM Open Jr/Little Britches Horse Western Rider Walk/Jog (Non-Qualifying) 119 Sr Long Stirrup Hunt Seat Equitation on the Flat Horse/Pony
90 BM Open Sr Western Rider Horse Walk/Jog (Non-Qualifying) 120 Sr Long Stirrup Bridle Path Hack Horse/Pony
91 BM Open Jr/Sr Western Rider Pony Walk/Jog (Non-Qualifying) 121 BM Open Jr Rider Hunter Horse Walk/Trot (Non-Qualifying)
92 Little Britches Western Pleasure (Walk/Jog) 122 Jr Rider Horse Hunter Under Saddle
93 Jr Rider Horse Western Pleasure 123 Jr Rider Horse Hunt Seat Equitation on the Flat
94 Sr Rider Horse Western Pleasure 124 Jr Rider Horse Bridle Path Hack
95 Jr/Sr Rider Pony Western Pleasure 125 BM Sr Rider Hunter Horse Walk/Trot (Non-Qualifying)
96 Little Britches Western Pleasure (Walk/Jog/Lope) 126 Sr Rider Horse Hunter Under Saddle
97 Jr/Sr Rider Western Pleasure Jr Horse/Pony (5 & Under) (Non-Qualifying) 127 Sr Rider Horse Hunt Seat Equitation on the Flat
98 Jr/Sr Rider Western Pleasure Sr Horse/Pony (6 & Up) (Non-Qualifying) 128 Sr Rider Horse Bridle Path Hack
99 Little Britches Western Horsemanship (Walk/Jog)
100 Jr Rider Horse Western Horsemanship
101 Sr Rider Horse Western Horsemanship
102 Jr/Sr Rider Pony Western Horsemanship
103 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.
62021 Official East Qualifying 4-H Horse Show April 30-May 2, 2021
Please: Only One Horse and One Exhibitor Per Form! Exhibitor Name:
4-H Club/County:
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
3 4 5 76 107 12 13 14 80 6 8 10 79 7 9 11 78 15 or 17, 16 or 18
1 75 105 106
108 109 118 119 120 112 114 116 111 113 115 19 81 122 123 124
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
15 or 17, 16 or 18 45 69 93 46 70 94
35 37 38 42 36 39 43 41 68 92 96 99
20 82 126 127 128 97* or 98*, 100 103 97* or 98*, 101 103
Jr/Sr Rider Pony Western Jr/Sr Stock Type Hunter Jr Rider Ranch Sr Rider Ranch Jr Rider Gaming Sr Rider Gaming
44 71 95 77 84 85 86 49 51 53 55 50 52 54 56
23 26 28 30 32 24 27 29 31 33
97 or 98, 102 103 64 72 65 73
Dressage* Warm Up 2’ O/F*/Combined Training Billy Murray* *Denotes Non-Qualifying Classes
21 25 34 66 83
57 58 59 60 There will be No Entries or Use “Stall Reservation Form”
2 89 90 91 104 Entries Must be in Your
61 62 110 117 121 125 Changes Accepted the day of the to reserve stall, shavings, and
show! RV Hookups. County Agent’s Hands
The following items MUST be included with your entry form for it to be considered complete:
Between March 17-31, 2021
1. Check Payable to “SED 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 2021 4-H Medical Release (Provided by Agent)
4. Copy of 2021 NC 4-H Horse Eligibility Card (Completed & Signed) (NO ORIGINALS) Total Entries @ $5.00/class (BM and Schooling):
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, 2021)
7. Copy (Paper Only) of Coggins – Required at check in and must be produced upon request.
No refunds after April 19, 2021 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):
72021 Official East Qualifying 4-H Horse Show April 30-May 2, 2021
Please: Only One Horse and One Exhibitor per form!
Cloverbud Registration Form (5-7 years old as of January 1, 2021) Exhibitor Name:
4-H Club/County:
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 (Intro Test B, walk/trot) Cloverbud Western Division Attire & Tack
74 87 88 63 40 47 48
Cloverbud Barrel Race (walk/trot) Cloverbud Trail (walk/trot)
67
22
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, 2021
The following items MUST be included with your entry form for it to be considered complete: show! RV Hookups.
1. Check Payable to “SED 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 2021 4-H Medical Release (Provided by Agent)
4. Copy of 2021 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 (Last page of Registration Packet)
Late Fee $30.00 (Entries Post Marked after March 31, 2021)
7. Copy (Paper Only) of Coggins – Required at check in and must be produced upon request.
No refunds after April 19, 2021 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):
82021 Official East Qualifying 4-H Horse Show April 30-May 2
STALL RESERVATION FORM
Questions about stalls? Contact: Jessica Manning Email: jessica_manning@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 19, 2021, 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 30th, 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) $50.00
Tack Stalls (includes 2 bags of shavings) $50.00
Extra Shavings $6.00 / 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, 2021.
Checks should be payable to the “SED 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_____________ __________
92021 Official East Qualifying 4-H Horse Show April 30-May 2
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 INDEMNIFICATION 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: ________________________________
102021 Official East Qualifying 4-H Horse Show April 30-May 2
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. **Due to COVID-19 Guidelines, this show will be
videoed and livestreamed. Not allowing photo/media use will result in not being able to show your horse due to the
COVID-19 guidelines outlined by North Carolina Livestock and Horse Show considerations.
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: ________________________________
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
112021 Official East Qualifying 4-H Horse Show April 30-May 2
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.
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
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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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