4-H Horse Project

4-H Packing Clinics:

Other Horse Clinics:

Jan. 9th-Into to Packing,

1pm Family Life Christian Church

Jan. 23rd-Clinic I, 10am

Country Kitchen

Feb. 13th-Clinic II, 10am

Country Kitchen

March 27th-Clinic III, 10am

Bad Rock Arena

April 17th, Clinic IV, 10am

Bad Rock Arena

My Horse’s Name

(include horse’s full name plus nickname)

Horse’s Birthdate

Mare or Gelding

Color & Markings

(example: Sorrel with four white socks and a blaze)

Height of Horse

Person My Horse is Owned By or Leased From

Parent Signature________________________________________________________

4-H Member’s Signature__________________________________________________

Flathead County 4-H Horse Camp

April 30-May 2, 2021

Flathead County Fairgrounds

Dear 4-H Parents & Members:

This is our Annual Flathead County 4-H Horse Camp. Enclosed is the registration packet. This event is for active 4-H members and other youth who would like to attend. Please read through the packet carefully and feel free to contact the Extension Office if you have any questions at 758-5553 or Cheryl Favre 270-0669.

Registrations are due to the Extension Office no later than Friday, April 23, 2021. Early bird registration runs now through April 9, 2021 and will be $65.00 per 4-H member and $90 per non-member. A registration fee of $75.00 will be charged after April 9th; $100 for non-members. If there are multiple participants attending camp from the same household, a “household discount” of $15 per member will be allowed. 

A t-shirt and all meals are included with registration. There are no price breaks for partial attendance and $15.00 of your registration fee is non-refundable. A silent auction and other camp merchandise including baseball hats and pull-over jackets will be available during camp. Please bring funds if you choose to purchase items at camp.

A limited number of partial scholarships in the amount of $50 for camp registration fees may be available upon written scholarship requests. Requests may be turned in to the Extension Office or email to Cheryl Favre, cfavre@cmgengineering.com. You will be notified of acceptance or denial within a few days of submitting your request.

Stall fees of $10.00 per stall will be charged; however, $5.00 will be refunded at the end of camp if the stall is clean. (Fee includes one bag shavings. Additional bags available for $5.00 each or can  be donated back to Horse Camp Fund)

                 * No Stallions are allowed at camp.

                 * Advanced horsemanship members may consider bringing a young horse to camp for  experience. 

                                  - It is recommended that they bring a riding horse as well.

                 * Members are responsible for caring for their own animal.  Chaperones may assist.

                 * Members must strip their stall before they leave.

                 * Fresh water must be in front of your horse when they are in a stall.

                 * Members must be in control of your horse at all times. Do not bring a horse to camp that you cannot control.  

                 * Parents and relatives are there to observe and chaperone, provide assistance as needed.

                 * Non-participating siblings will be under the supervision of an adult.

                 * Visitors are welcome to attend. Meals must be pre-ordered and cost $5 per meal. 

                 * Members should bring the horse that they have identified as their project animal.

Members are required to have a chaperone present during clinic hours. These hours are Friday, April 30, 2021 from 4:00pm-9:30pm, Saturday, May 1, 2021 from 8:30am-9:00pm and on Sunday, May 2, 2021 from 8:30am-4:00pm. Chaperones are charged a fee of $35.00 for a t-shirt and meals, which includes Friday’s dinner, three meals on Saturday, and two meals and a snack on Sunday. A schedule of events is attached to this packet. Members who are unable to tack-up their own horse will require a chaperones help. A chaperone may be responsible for up to no more than 5 campers. Overnight chaperones are encouraged.

Member Registration

Mailing Address:

MSU Extension, Flathead County

1108 South Main Street Ste. 4

Kalispell, MT 59901

Phone: 406-758-5553

Fax: 406-758-5881

Email: extension@flathead.mt.gov

Montana State University Extension is committed to ensuring the civil rights of its clients and employees. Every client and every employee must be treated fairly and equitably, with dignity and respect. This policy applies to all clients and employees – regardless of race, color, national origin, gender, religion, age, disability, political beliefs, veterans status, sexual orientation, citizenship, and marital or family status.

Montana State University Extension encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of special accommodations or have questions about the physical access provided, please contact Flathead County Extension Office at 758-5553 in advance of your participation or visit.

4-H camp participants are asked to stay with other members in the designated sleeping area unless camp staff is otherwise notified.

We will have a “Free Item Table” for participants to donate/share with others (New or Used). We will also be holding a silent auction during camp filled with fun merchandise that campers or parents/chaperones may be interested in purchasing. For this, please bring only New items. See the schedule of events for details. All proceeds will be used for the 4-H Horse Program.

Things you need to bring with you:

             Water Bottle (s)                                                                             Sleeping Bag & Pillow

             Cot or Air Mattress (strongly recommended)                                       Toiletries

             Medications (must be turned into the camp nurse)                A Towel

             Riding clothes and boots (no tennis shoes for riding)                          A Notebook/writing utensils

             Riding Helmet (unless a waiver has been signed)                    4-H Horsemanship Workbooks           

             *Money to purchase silent auction items or other camp merchandise                                               

Please use discretion when bringing valuables to horse camp.  Please clearly label all valuables. The Flathead 4-H Foundation is not responsible for lost or stolen items.

Things your horse needs:

             Feed (hay or grain)                                              Water Buckets

             Grooming Tools                                                   Saddle & Tack (show items are not necessary)                                       Stall Cleaning Items (wheel barrow and forks are optional but strongly encouraged.)

             Additional shavings if desired.

Please clearly label all belongings.

Immunizations are recommended but are at the discretion of the horse owner.

Flathead County

4-H Horse Camp

April 30-May 2, 2021

Flathead County Fairgrounds

For Office Use Only:

Date:                                          Amount:

Check      Check No.         Cash       

Participant’s Name:                                             Age:                         DOB:

Address:                                                  City:                                             Zip:

Phone:                                        M                       F                4-H Club:

Cell:                                              Email:

Horsemanship Projects  & Levels Currently Enrolled in:

Parents Name:                                                                 Interested in being Overnight Chaperone?   Y          N

                                                                                                                                                                                         Circle One

Each child is required to have an adult chaperone during clinic hours, (Friday 4:00pm -9:30pm, Saturday 8:30am-9:00pm, & Sunday 8:30am-4:00pm). An adult may chaperone up to 5 members. Chaperones are required to pay $35.00 for meal expense and are welcome to attend all meals provided. Chaperone fees also include a free camp t-shirt.  Chaperones must fill out a separate registration form.  Guests, siblings and non-chaperone parents who will be joining us for meals must pay $5 per meal in advance. 

Name of Chaperone:                                                                                  Phone:

Fees: Partial scholarships in the amount of $50  for registration fees may be available upon written request. 

                 Member Early Bird Registration Fee by April 9th- $65.00 or $90 non-members             

                 Member Registration Fee by April 23rd- $75.00 or $100 non-members                             

                 Multi-Household member discount -  Yes or No   Amount                                                                         

                 Stall Fee- $10.00 (includes 1 bag shavings). Extra bags $5.00                                                 

                 Extra Stall- $10.00/stall     # of Stalls                                X $10.00=                                                                 

                 $5.00 of stall fees are refundable at the end of camp if clean or may be donated back to Horse Camp

                 To help chaperones assist my child and others I would like to stall near the following campers:

                 1.                                                                                  2.

                 3.                                                                                  4.

                                  Guest Meals: ($5 per meal per guest)

                 Friday Dinner:                                                          (# of Guests)

                 Saturday:    Breakfast                           Lunch                      Dinner                   

                 Sunday:      Breakfast                            Snack                      Dinner    

                 Clothing available in youth and adult sizes: XS, S, M, L, XL, & XXL    

                 T-Shirt- (1st is Free, additional $15 each) Size:           Quantity:               Youth:                      Adult:     

                 (additional camp merchandise including baseball caps and pullover jackets will be available at camp)                   

                 Please make checks payable to the Flathead 4-H Horse Committee: Total:

CODE OF CONDUCT FOR 4-H MEMBERS

Name County

The 4-H Center & Montana State University Extension wants your participation in 4-H events and activities to be filled with exciting experiences, new friendships and fun. To ensure a positive experience for all participants, it is expected that each participant be considerate of others, participate fully in the programming and observe the following expectations (if a situation or question arises which is not clearly covered by this list, ask a chaperone or staff person before acting).

• I will conduct myself at all times in order to be a credit to the club, school and community. • I will dress neatly and appropriately for the occasion. • I will show respect for the rights of others to be courteous at all times. • I will be honest and not take unfair advantage of others. • I will respect the property of others. • I will refrain from loud boisterous talk, swearing and horseplay. • I not use my personal vehicle when it is not allowed by an event or trip. • I will demonstrate sportsmanship in the contests and meeting, modesty in winning and generosity in defeat. • I will attend sessions promptly and respect the opinion of others in discussion. • I will not purchase or have in my possession any kind of alcoholic beverage, drugs or tobacco. • I will care for the motel/hotel property and respect the rights of other guests of the motel/ hotel/ dorm and observe all rules instituted by the property. • I will be in my room and stay there after curfew time and I will be dressed and out of my room each day by the set time given by the chaperon(s). • I will be prepared to report to my club and other clubs knowledge gained by attending these activities. • I will respect supervision at all times, being responsible to all adults connected with the trip or event.

I have read the above Code of Conduct and understand that my infraction of any of the above rules will be cause for my participation in the trip or event to be terminated and for me to be sent home at my own expense.

Signature of 4-H Member                                                                                                 Date      

Parent/Guardian Signature                                                                                              Date

County Agent Signature                                                                                                     Date

Medical Release Form for 4-H Youth & Adults

PARTICIPANT INFORMATION:

Name:                                                                                                          County:

Address:

Name of Parent or Legal Guardian: (YOUTH ONLY):

Primary Physician:                                                                                                                   Phone:

Dentist:                                                                                                                                         Phone:

IN CASE OF EMERGENCY:

Primary Contact:                                                                                                                      Phone:

Relationship:                                                                                                             City:                                                           State:

Alternate Contact:                                                                                                                   Phone:

Relationship:                                                                                                             City:                                                           State:

INSURANCE INFORMATION

Name of Insurance Carrier:

Policy Holder Name:                                                                                              Policy #:

Date of Last:

Tetanus Shot:                       Polio Shot:                             Mumps Shot:                        Measles Shot:                      Rubella Shot:

Medical Information: (check all that apply and explain if necessary)

□ Stomach or Intestinal problems

□ Diabetes or hypoglycemia (low blood sugar)

□ Nervous disorder (convulsions, epilepsy, dizziness, ect)

□ Respiratory problems

□ Heart Disease

□ Any allergies to medication

□ Any allergies to food or plants

□ Special diet or food restrictions

□ Are you currently under a doctor's care?

□ Are you currently taking medications?

□ Are there any physical restrictions or medical problems

that may require special considerations?

AUTHORIZATION FOR TREATMENT (YOUTH ONLY)

I,                                do herby give permission to         

to seek and obtain any medical care necessary for my child             .

Parent/Guardian Signature                                                                                                 Date

ALL PARTICIPANTS

To the Best of my knowledge, accurate information has been provided in all areas of this form.

Participant Signature (youth/ adult)                                                        Date

IF YOUTH: Parent/Guardian Signature                                                    Date

The Montana State University Extension Service is an ADA/EO/AA/Veteran's Preference Employer and Provider of Educational Outreach.

PARENT/GUARDIAN Name CHAPERONE Name

YOUTH Participant Name

MEDIA RELEASE FORM

Montana State University Extension

Name of participant:

County:                                                                                           4‐H Year:

MSU Extension  4-H would like to use photos or video of your child during 4‐H events or activities to use in

press releases and other publicity. The photo or film may be used for the following purposes:

• Website

• Press Release

• News Story

• Marketing Materials

• Other

CONDITIONS OF USE:

1. We will not use personal details or full names (first name and last name) of any child in a photograph on

our web site.

2. We will not include personal e‐mail or postal addresses or telephone numbers on our web site or in other

printed publications.

3. We may use the name of the child in accompanying text or a photo caption.

I DO authorize the use of photos or video of my child at 4-H events or activities.

I DO NOT authorize the use of photos or video of my child at 4-H events or activities.

I have read, consent, and agree, individually and, as a parent or guardian of the minor named

above, to the foregoing terms and provisions. I warrant that I am of full legal age and have every

right to contract for the minor in the above regard.

Parent or Guardian Signature                                                                 Date     

The U.S. Department of Agriculture (USDA), Montana State University and the Montana State University Extension prohibit discrimination in all of their programs and activities on the basis of race, color,

national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital and family status. Issued in furtherance of cooperative extension work in agriculture and home economics,

acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture, Jill Martz, Director of Extension, Montana State University, Bozeman, MT 59717.

 4-H Horse Helmet Policy & Signed Form

 Acknowledgement of Education

 4-H YEAR from:

to:

County:

Participant Name:

Birth Date: MM/DD/YYYY

Montana State University Extension: 4-H Horse Helmet Policy

A certified equestrian helmet with safety harness fastened in place is required in over fence classes and gymkhana events, activities, and practice sessions. Gymkhana refers to horseback speed events (timed or un-timed) that do not use livestock. Events that usually fall in this category include, but are not limited to: barrel racing, pole bending, keyhole races, stake races, rescue races, pony express race, etc. Events that are not intended to be included in this policy are events such as calf roping, team roping, goat tying, and team penning that may be timed but use

livestock.

Participants in the 4-H Horse Project are required to attend a helmet education workshop and/or view the video

"Every Ride Every Time" once as a junior 4-H member (9-13) and once as a senior 4-H member (14 and up).

It is the responsibility of the parent or guardian of the 4-H member to see that the headgear worn complies with such standards and is in good condition. The Montana 4-H Center for Youth Development encourages the use of ASTM certified/SEI approved safety helmets in all equine events. Protective headgear may be used in all classes and shall not be discriminated against.

Helmet use is encouraged in all 4-H horse activities any time a 4-H member is around a horse. Counties may establish more stringent policies regarding helmet use.

I have read, understand, and agreed to adhere to the above Montana 4-H Horse Helmet Policy in order to participate in the Montana 4-H Horse Project.

 Participant Signature:

Date:

signatures are required yearly

 Montana State University Extension:

4-H Acknowledgement of Receiving Horse Helmet Education

I have attended a 4-H horse helmet safety workshop and/or viewed the video “Every Time, Every Ride”. I

acknowledge that helmet education is required twice during my 4-H membership - first in my junior years, 4-H age 9-13, and again in my senior years, 4-H age 14 and up, unless I joined 4-H as a senior member whereas I need only receive training once.

 Participant Signature:

Date of Education:

Printed Name of Parent or Legal Guardian:

Signature:

Date:

signatures are required yearly

Flathead County 4-H Horse Camp

April 30-May 2, 2021

Flathead County Fairgrounds

Dear 4-H Parents & Members:

This is our Annual Flathead County 4-H Horse Camp. Enclosed is the registration packet. This event is for active 4-H members and other youth who would like to attend. Please read through the packet carefully and feel free to contact the Extension Office if you have any questions at 758-5553 or Cheryl Favre 270-0669.

Registrations are due to the Extension Office no later than Friday, April 23, 2021. Early bird registration runs now through April 9, 2021 and will be $65.00 per 4-H member and $90 per non-member. A registration fee of $75.00 will be charged after April 9th; $100 for non-members. If there are multiple participants attending camp from the same household, a “household discount” of $15 per member will be allowed. 

A t-shirt and all meals are included with registration. There are no price breaks for partial attendance and $15.00 of your registration fee is non-refundable. A silent auction and other camp merchandise including baseball hats and pull-over jackets will be available during camp. Please bring funds if you choose to purchase items at camp.

A limited number of partial scholarships in the amount of $50 for camp registration fees may be available upon written scholarship requests. Requests may be turned in to the Extension Office or email to Cheryl Favre, cfavre@cmgengineering.com. You will be notified of acceptance or denial within a few days of submitting your request.

Stall fees of $10.00 per stall will be charged; however, $5.00 will be refunded at the end of camp if the stall is clean. (Fee includes one bag shavings. Additional bags available for $5.00 each or can  be donated back to Horse Camp Fund.)

                 * No Stallions are allowed at camp.

                 * Advanced horsemanship members may consider bringing a young horse to camp for  experience. 

                                  - It is recommended that they bring a riding horse as well.

                 * Members are responsible for caring for their own animal.  Chaperones may assist.

                 * Members must strip their stall before they leave.

                 * Fresh water must be in front of your horse when they are in a stall.

                 * Members must be in control of your horse at all times. Do not bring a horse to camp that you cannot control.  

                 * Parents and relatives are there to observe and chaperone, provide assistance as needed.

                 * Non-participating siblings will be under the supervision of an adult.

                 * Visitors are welcome to attend. Meals must be pre-ordered and cost $5 per meal. 

                 * Members should bring the horse that they have identified as their project animal.

Campers are required to have a chaperone present during clinic hours. These hours are Friday, April 30, 2021 from 4:00pm-9:30pm, Saturday, May 1, 2021 from 8:30am-9:00pm and on Sunday, May 2, 2021 from 8:30am-4:00pm. Chaperones are charged a fee of $35.00 for a t-shirt and meals, which includes Friday’s dinner, three meals on Saturday, and two meals and a snack on Sunday. A schedule of events is attached to this packet. Members who are unable to tack-up their own horse will require a chaperones help. A chaperone may be responsible for up to no more than 5 campers.

Chaperone Registration

Mailing Address:

MSU Extension, Flathead County

1108 South Main Street Ste. 4

Kalispell, MT 59901

Phone: 406-758-5553

Fax: 406-758-5881

Email: extension@flathead.mt.gov

Montana State University Extension is committed to ensuring the civil rights of its clients and employees. Every client and every employee must be treated fairly and equitably, with dignity and respect. This policy applies to all clients and employees – regardless of race, color, national origin, gender, religion, age, disability, political beliefs, veterans status, sexual orientation, citizenship, and marital or family status.

Montana State University Extension encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of special accommodations or have questions about the physical access provided, please contact Flathead County Extension Office at 758-5553 in advance of your participation or visit.

4-H camp participants are asked to stay with other members in the designated sleeping area unless camp staff is otherwise notified.

We will have a “Free Item Table” for participants to donate/share with others (New or Used). We will also be holding a silent auction during camp filled with fun merchandise that campers or parents/chaperones may be interested in purchasing. For this, please bring only New items. See the schedule of events for details. All proceeds will be used for the 4-H Horse Program.

Things you need to bring with you:

             Water Bottle (s)                                                                             Sleeping Bag & Pillow

             Cot or Air Mattress (strongly recommended)                                       Toiletries

             Medications (must be turned into the camp nurse)                A Towel

             Riding clothes and boots (no tennis shoes for riding)                          A Notebook/writing utensils

             Riding Helmet (unless a waiver has been signed)                    4-H Horsemanship Workbooks           

             *Money to purchase silent auction items or other camp merchandise                                               

Please use discretion when bringing valuables to horse camp.  Please clearly label all valuables. The Flathead 4-H Foundation is not responsible for lost or stolen items.

Things your horse needs:

             Feed (hay or grain)                                              Water Buckets

             Grooming Tools                                                   Saddle & Tack (show items are not necessary)                                       Stall Cleaning Items (wheel barrow and forks are optional but strongly encouraged.)

             Additional shavings if desired.                                                   

Please clearly label all belongings.

Immunizations are recommended but are at the discretion of the horse owner.

Flathead County

4-H Horse Camp

April 30-May 2, 2021

Flathead County Fairgrounds

For Office Use Only:

Date:                                                           Amount:                 

Check      Check No.         Cash       

Chaperone’s Name:                                                                                   Are you over 21 years of age?  Y    N

Address:

Phone:                                                       M                      F                          4-H Club:

Email:                                                                                               Cell:

Are you interested in being an overnight chaperone:   Y          N

                                                                                              Circle One

Each child is required to have an adult chaperone during clinic hours, (Friday 4:00pm -9:30pm, Saturday 8:30am-9:00pm, & Sunday 8:30 am-4:00pm).  An adult may chaperone up to 5 members.  Chaperones are required to pay $35.00 for meal expense, and are welcome to attend all meals provided. 

Camper #1                                                                         Camper #2

Camper #3                                                                         Camper #4

Camper #5

Fees:

             Chaperone Fee- $35.00                                                               

             T-Shirt- (1st is Free, additional $15 each)        Size:                   Quantity:

             Sweatshirt        $25.00                                         Size:                   Quantity:         

             Clothing available in adult sizes: XS, S, M, L, XL, & XXL        

             (additional camp merchandise including baseball caps and pullover jackets will be available at camp)

             Guest Meals: ($5 per meal per guest)

             Friday Dinner:                                         (# of Guests)

             Saturday:    Breakfast                             Lunch                 Dinner

             Sunday:      Breakfast                               Snack                Dinner

Please make checks payable to the Flathead 4-H Horse Committee.           Total:   

Medical Release Form for 4-H Youth & Adults

PARTICIPANT INFORMATION:

Name:                                                                                                                           County:

Address:

Name of Parent or Legal Guardian: (YOUTH ONLY):

Primary Physician:                                                                                                                   Phone:

Dentist:                                                                                                                                         Phone:

IN CASE OF EMERGENCY:

Primary Contact:                                                                                                                      Phone:

Relationship:                                                                           City:                                                                            State:

Alternate Contact:                                                                                                                   Phone:

Relationship:                                                                           City:                                                                            State:

INSURANCE INFORMATION

Name of Insurance Carrier:

Policy Holder Name:                                                                                                                                Policy #:

Date of Last:

Tetanus Shot:                       Polio Shot:                             Mumps Shot:                        Measles Shot:                      Rubella Shot:

Medical Information: (check all that apply and explain if necessary)

□ Stomach or Intestinal problems

□ Diabetes or hypoglycemia (low blood sugar)

□ Nervous disorder (convulsions, epilepsy, dizziness, ect)

□ Respiratory problems

□ Heart Disease

□ Any allergies to medication

□ Any allergies to food or plants

□ Special diet or food restrictions

□ Are you currently under a doctor's care?

□ Are you currently taking medications?

□ Are there any physical restrictions or medical problems

that may require special considerations?

AUTHORIZATION FOR TREATMENT (YOUTH ONLY)

I,                                                                  do herby give permission to

to seek and obtain any medical care necessary for my child                                                                                .

Parent/Guardian Signature                                                                                                                                   Date

ALL PARTICIPANTS

To the Best of my knowledge, accurate information has been provided in all areas of this form.

Participant Signature (youth/ adult)                                                                                  Date

IF YOUTH: Parent/Guardian Signature                                                                              Date

The Montana State University Extension Service is an ADA/EO/AA/Veteran's Preference Employer and Provider of Educational Outreach.

PARENT/GUARDIAN Name CHAPERONE Name

YOUTH Participant Name

MEDIA RELEASE FORM

Montana State University Extension

Name of participant:

County:                                                                                                        4‐H Year:

MSU Extension  4-H would like to use photos or video of your child during 4‐H events or activities to use in

press releases and other publicity. The photo or film may be used for the following purposes:

• Website

• Press Release

• News Story

• Marketing Materials

• Other

CONDITIONS OF USE:

1. We will not use personal details or full names (first name and last name) of any child in a photograph on

our web site.

2. We will not include personal e‐mail or postal addresses or telephone numbers on our web site or in other

printed publications.

3. We may use the name of the child in accompanying text or a photo caption.

I DO authorize the use of photos or video of my child at 4-H events or activities.

I DO NOT authorize the use of photos or video of my child at 4-H events or activities.

I have read, consent, and agree, individually and, as a parent or guardian of the minor named

above, to the foregoing terms and provisions. I warrant that I am of full legal age and have every

right to contract for the minor in the above regard.

Parent or Guardian Signature                                                                                           Date

The U.S. Department of Agriculture (USDA), Montana State University and the Montana State University Extension prohibit discrimination in all of their programs and activities on the basis of race, color,

national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital and family status. Issued in furtherance of cooperative extension work in agriculture and home economics,

acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture, Jill Martz, Director of Extension, Montana State University, Bozeman, MT 59717.