DISTRICT 4-H Horse Show Entry Form

2019 DISTRICT 4-H Horse Show Entry Form

Entry Deadline: May 1

Is exhibitor a JUNIOR or SENIOR 4-H member?

4-H county:

Exhibitor name:

Birthdate:

Phone:

Exhibitor mailing address:

Name of horse:

Horse’s birthdate:

Is this a HORSE or PONY? If pony, select a height: small/medium pony (13 hands & under)

OR large pony (over 13 to 14.2 hands)

Breed of horse or pony:

Horse’s registration or grade number:

Owner of horse:

Relationship of owner to exhibitor:

PLEASE INDICATE WHICH CLASSES YOU ARE ENTERING

List number(s) of class(es) you are entering between 1 and 100.

NOTE: Classes 21, 22,23,24, 36, 39, 40, and 41 have extra instructions*.

Class 98: Chose header or heeler and list your Team Roping partner.

Other Classes (enter class name)

*NOTE: A horse/rider combination may participate in only one trail class (either 50–51 Western Trail or 104–105 Ranch Trail), one pleasure class (either 36 Pony Pleasure/39–42 Western Pleasure or 102–103 Ranch Riding), and one showmanship class (21–24/25–26 Saddle/Gaited Horse or 106–107 Ranch Ground Handling).

I permit Mississippi State University’s Office of Agricultural Communications and Department of Animal and Dairy Sciences to record my, my child’s, my family member’s, and my horse’s image, video, voice, or all of these and own and use those recordings for educational and publicity purposes. I release Mississippi State University, the Office of Agricultural Communications, and the Department of Animal and Dairy Sciences from any claims that might arise from use of these recordings. If subject is under 18, a parent, grandparent, or guardian must write the child’s name as the exhibitor and grant permission by signing on the appropriate line.

THESE SIGNATURES CERTIFY THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO ABIDE BY THE MISSISSIPPI 4-H HORSE SHOWS CLASSES, RULES, AND REGULATIONS.

Exhibitor’s signature:

Parent’s signature:

Extension agent’s signature:

Date:

Send original entry form to district horse show secretary and make a copy for the exhibitor and Extension agent.

Produced by Agricultural Communications. Mississippi State University is an equal opportunity institution.

For disability accommodation, please contact Dean Jousan at (662) 325-2424 or dean.jousan@msstate.edu.

Extension Service of Mississippi State University, cooperating with U.S. Department of Agriculture. Published in furtherance of Acts of Congress, May 8 and June 30, 1914. GARY B. JACKSON, Director

Form 1144 (POD-03-19)