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
Hosted by the Northeast & Southeast
4-H Horse Councils
Senator Bob Martin Eastern Agricultural Center
Williamston, NC
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
22022 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
32022 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.
42022 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.
52022 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.
62022 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):
72022 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):
82022 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_____________ __________
92022 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: ________________________________
102022 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: ________________________________
112022 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.
122022 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: _________________________________
132022 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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