8:30am-2:00pm Saturday, March 18, 2017

Southwest Virginia Higher Education Center Abingdon, VA

WHAT:

MODEL HORSE SHOW Judges will briefly discuss: ♦ What to look for in selecting show models ♦ How to show them ♦ Various classes offered at model shows 4-H’ers should bring their favorite equine models including mules, donkeys and zebras. There are a few classes for other animal models. Models can be any kind (Breyer, Stone or other), any breed, color, and size. They may be made of plastic, metal, resin or china – no stuffed toys. 4-H’ers may only show one or two models per class. Models may not be shown in more than one specific breed class but may be shown in one Performance, one Breed and the Scenes and Collections classes. The show will have Halter Classes for breeds, Best Scene Class (models arranged in barn, pasture, with other horses, mare and foal, etc.), Costume Class – (anything goes). You don’t have to display them with a doll. Exhibitors may bring horse reference books / pictures to help identify and describe the model being shown. (Judges like to see that youth have researched the breed being shown).

WHEN:

Saturday, March 18, 2017 / 8:30 AM – 2:00 PM Registration at 8:30AM, Show starts at 9:00AM In the event of inclement weather, a snow date will be announced later. You may call Sam Leech, 4-H Agent, Tazewell County 276-988-0405 or Lauren Kopp, 4-H Agent, Smyth County (276) 783-5175.

WHO:

Youth (ages 5-18) only- **Youth must be accompanied by a parent or guardian!**

WHERE:

Southwest Virginia Higher Education Center- 1 Partnership Circle, Abingdon, VA 24210, Room 103

COST:

$10.00 per youth participant. Checks should be made out to VCE Tazewell County. Mail: Registration Fee, completed Health History, and Code of Conduct Form VCE – Tazewell County 4-H Model Horse Show P.O. Box 229 Tazewell, VA 24651

Registration Forms need to be received NO LATER than March 10, 2017. If you have any questions or cannot make the deadline, please contact the Tazewell County Extension Office at (276)988-0405. ***We HAVE to know how many youth are planning to participate in advance of the Show!***

Definitions TACK – saddles, bridles, halters, carriage, harness wagon, sleigh, plow, blankets, leg wraps. PROPS – These are inanimate objects such as trees, bridges, trail set-ups, jumps, packs, etc. DOLLS – These are the men, women and children used as rider, driver, handler, or addition to the scene. SUPPORTING CAST – Dogs, cows, calves, birds, chickens – used in showing horses. Animals must be in scale for use with horse being shown in Best Scene Class. COLLECTIONS – (Minimum of 6 to a collection) Collection must have a common theme, i.e.: all ponies, all foals, one breed, one discipline, one mold EXOTIC ANIMALS – Wildlife or domesticated animals to include zebras, dogs & cats. Show Committee Reserves The Right To Combine/Add/Drop Classes As Needed.

DIVISION I – PERFORMANCE CLASSES (Horses or ponies with tack and/or props to simulate specific discipline in action. Doll riders are not required.) 1. Hunt Seat Pleasure 2. Hunter/Jumper, Cross Country or Stadium Jumping, Trail 3. Dressage 4. Long Ear Pleasure 5. Long Ear Working, Gymkhana, Cutting, Packing, Trail 6. Western Pleasure 7. Western Working, Gymkhana, Cutting, Western Trail 8. Saddle Seat – Gaited / Non-Gaited 9. Saddle Seat Trail 10. Harness Horse (Light, Medium, Heavy, Draft Horse) 11. Harness Pony 12. Division I Championship

DIVISION II – HALTER DIVISION (Horses are not required to have halters and should not have any other tack.) Gaited Horses (position of legs should show a gait other than trot or canter) 13. Five-Gaited American Saddlebred 14. Tennessee Walking Horse

15. Paso Fino 16. Peruvian Paso 17. Gaited Mules 18. Rocky Mountain Horses 19. Racking Horses 20. Missouri FoxTrotter 21. Gaited Donkeys 22. Gaited Foals 23. Gaited Championship Light Breeds - Trotting 24. American Saddlebred 25. Standardbred 26. Lippazaner 27. Akhal-Teke 28. National Show Horse 29. Warmblood 30. Andalusian / Lusitano 31. Morgan 32. Morab 33. Thoroughbreds 34. Arabians 35. Arabian Crossbreds 36. Hanoverian 37. Pinto 38. Other Sport Horses 39. Foals 40. Light Trotting Breed Championship Long Ears 41. Mules 42. Donkeys 43. Foals 44. Long Ears Championship Draft Horses & Ponies - Light Draft 45. Haflinger

46. Cleveland Bay 47. Friesian 48. Norwegian Fjord 49. Drum / Gypsy 50. Other Draft Horses - Medium & Heavy 51. Shire 52. Suffolk 53. American Draft 54. Clydesdale 55. Belgian 56. Percherons 57. Foals 58. Draft Division Championship Stock Horses 59. Quarter Horses 60. Paints 61. Appaloosa 62. Mustang 63. Apaco Barb 64. Palomino 65. Foals 66. Stock Horse Championship Ponies 67. Stock Pony 68. POA 69. Chincoteague 70. Hackney 71. Americana (Fine Harness Pony) 72. Shetland 73. Connemara 74. Miniature Horse 75. Welsh 76. Welsh Cob 77. Icelandic 78. Foals 79. Other 80. Ponies & Miniature Horse Championship Exotic & Domesticated Animals 81. Wildlife (other than horses) 82. Dogs 83. Cats 84. Cattle 85. Other Farm Animals 86. Exotic Animals - Championship

DIVISION III – MISCELLANEOUS 87. Fantasy Horse/Animal (EX: Horses performing feats that only horses in your fantasy could do. EX: Pegasus flying; dancing

Unicorns; ponies playing basketball; mules riding skateboards, etc.) 88. Parade Class – Horses to be shown with fancy tack (‘silver’ on a western saddle, silver hooded stirrups etc.) that would be used in a true Parade Class at a horse show 89. Mare and Foal Class 90. Collections - Six animals with a common theme –exhibitor must explain or describe the theme 91. Collections - Three or more animals of the same mold 92. Re-made models (horses that have been hand painted or handcrafted in some way). This does not mean their tack is handmade. 93. Handmade tack. 4-Her has made or created tack for the model. 94. Costume Class - Store Bought/Pre made 95. Costume Class - Handmade/Created 96. Most Loved. 97. MISCELLANEOUS CHAMPIONSHIP 98. The Novice Class (has not won a ribbon today) (No tack required)  RESERVE GRAND CHAMPION  GRAND CHAMPION

SCENE CLASSES Model horses displayed in a real-life setting. EX: Horses tied to trailer at a show; barn with horse & stall; mare and foal in pasture with water trough/creek, performing circus/trick horse in ring. Scenes must be set up by 11:00am. 99. Best Large Scene Class 100. Best Small Scene Class 101. Exotic Animals In A Scene 102. Scene Championship  SPORTSMANSHIP AWARD  EVALUATION

4-H Health History Report form Publication 388-906 Reviewed 2016

INSTRUCTIONS: Please provide detailed health information for determining appropriate supervision, support, and accommodations for the 4-H activity or event listed. A parent or guardian must sign. If the participant is a person with a disability and desires any assistive devices, services or other accommodations to participate in this activity, please contact your local Extension office during business hours at least 7 days prior to the event to discuss accommodations. PLEASE PRINT ALL INFORMATION. (NOTE: Both sides of this form must be completed.) Name of 4-H event in which you wish to participate: __________________________________________________________________ Date(s) of event: _________________________________ Location: ___________________________________________________ PARTICIPANT IDENTIFICATION Name: _________________________________________________________________________________ Last

First (Underline name by which you like to be called)

Middle

Female: ■

Male: ■

Mailing address: _____________________________________________________ Participant cell phone: ( ______ ) _______________ City: ____________________________ State: _____ ZIP: _____________ Home phone: ( _______ ) _____________________ Age: __________

Birthdate: ___________________ Home email: _______________________________________

Ethnicity (choose one): Hispanic/Latino ■

Not Hispanic/Latino ■

Race (choose all that apply): American Indian/Alaskan Native ■ Asian ■ Black/African American ■ Native Hawaiian/Other Pacific Islander ■ White ■ PARENT / GUARDIAN IDENTIFICATION (Place a check beside who to reach in the event of an emergency.) ■ First parent/guardian name: ________________________________ First parent/guardian email: ___________________________ First parent/guardian phone daytime: _____________________ Evening: ____________________ Cell: _____________________ ■ Second parent/guardian name: ______________________________ Second parent/guardian email: __________________________ Second parent/guardian phone daytime: _____________________ Evening: ______________________ Cell: _________________ Who has primary custody of the participant? ________________________________________________________________________ Address, if different than child: ____________________________________________________________________________________ 4-H PARTICIPANT MEDIA RELEASE

PHYSICIAN / INSURANCE INFORMATION Family physician name: _________________________________________________ Phone: ( ________ ) _________________________ Dentist/orthodontist name: __________________________________________ Phone: ( ________ ) _________________________ Do you carry family medical / hospital insurance?:

Yes ■ No ■

(Check ✔ one) Carrier: ______________________________________________

Policy ID #: _____________________________________________ EMERGENCY CONTACT INFORMATION (Parts 1 and 2 should be completed) 1. Where can you be reached in the event of an emergency? Location:___________________________________________________________ Phone: ( ______ ) __________________________ Cell phone: ( ______ ) _____________________ 2. If you Cannot be reached, who should be notified? Name: ____________________________________________________________ Home phone: ( ______ ) ____________________ Work phone: ( ______ ) ____________________ Cell phone: ( ______ ) _____________________

The Virginia Polytechnic Institute and State University/College of Agriculture and Life Sciences (CALS) periodically uses electronic and traditional media (e.g., photographs, video, audio footage, testimonials) for publicity and educational purposes. By my signature on this form, I acknowledge receipt of this document and give permission to the College of Agriculture and Life Sciences and its designee to use such reproductions for educational and publicity purposes in perpetuity without further consideration from me. I understand that I will need to notify Virginia Tech/College of Agriculture and Life Sciences if any changes to my situation occur that will impact this media release permission. ■ Yes

■ No

(continued on back)

www.ext.vt.edu

* 18 U.S.C. 707

Produced by Communications and Marketing, College of Agriculture and Life Sciences, Virginia Tech, 2016 Virginia Cooperative Extension programs and employment are open to all, regardless of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, veteran status, or any other basis protected by law. An equal opportunity/affirmative action employer. Issued in furtherance of Cooperative Extension work, Virginia Polytechnic Institute and State University, Virginia State University, and the U.S. Department of Agriculture cooperating. Edwin J. Jones, Director, Virginia Cooperative Extension, Virginia Tech, Blacksburg; M. Ray McKinnie, Interim Administrator, 1890 Extension Program, Virginia State University, Petersburg. VT/1016/4H-696NP

PARTICIPANT HEALTH AND MEDICAL HISTORY (Questions 1-5 must be completed.)

APPROVAL / EMERGENCY AUTHORIZATION

1.

(Please read parts 1 and 2. If the participant is under 18, parents/guardians must sign in the space provided. If you are over the age of 18, please sign for yourself. If you cannot sign this due to religious reasons, you must contact your Extension office to obtain a legal waiver that must be signed. If this section is not signed, participation in the 4-H event/activity will not be allowed. You must contact your Extension office if there is a change in health status after submitting this form.

S  PECIAL DIETARY NEEDS INSTRUCTIONS: The purpose of this section is to communicate special dietary needs, food allergies, etc. for any child, teen, or adult who will be attending a 4-H event. In the space below, please list all food allergies and/or other dietary restrictions for the person listed above and any necessary precautions that should be taken: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

2.

H  as the participant ever experienced (or had special needs in) any of the following? [Check (✔) all that apply] ■  Asthma ■ Eating disorders ■ Diabetes ■ Fainting spells

■ Bleeding disorders ■ Seizures/Convulsions ■ Bed Wetting ■ Non-food allergies

■ Attention disorders (ADHD) ■ Wears contacts ■ Behavior ■ Other: ___________________

Please describe any condition or need that you checked: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

3. Is the participant experiencing any current health problems, under medical care, receiving mental or behavioral services, or currently taking medication?

■  YES ■ NO If YES, please explain: __________________________________ ___________________________________________________________________

4.

 as the participant undergone surgery, or experienced any injury, illness, allergy, H or change in health status any time during the last year? Is there any reason that participation in a program or activity should be restricted? ■  YES

■ NO If YES, please explain: __________________________________

___________________________________________________________________

1. I give my permission for the participant named on this form to attend the designated 4-H program. He / She has permission to participate in all activities which may include swimming and other water sports under the supervision of lifeguard(s) and to take part in other scheduled activities such as firearm safety, horsemanship, archery, low ropes, physical activity/exercise and related activities under the supervision of instructors; subject to limitations noted herein. 2. I hereby give permission to the medical staff person selected by the event/activity director to order X-rays, routine tests and treatment for my child (or for myself if I am a participant over 18 years old) as medically necessary. I also give permission for the participant to receive overthe-counter medication as needed under the guidance of the medical staff person. I understand that all attempts will be made to notify parents/guardians of any serious injury or illness to their child. If I cannot be reached in an emergency, I hereby give permission to the medical staff person to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for me/ or the participant named on this form. This form may be photocopied for use outside of the event/activity location. ADULT PRINTED NAME: ________________________________________________ SIGNED: X______________________________________ (Parent / Legal Guardian or participant over 18 years old)

Date: _______________________ I understand and agree to abide with any restrictions placed on my activities according to this form.

5. What else should we know about your child? 4-H programs include very rewarding, but sometimes challenging situations. Please inform us of any concerns that may arise related to your child’s physical, mental, emotional, and/or social health in order that we may better provide appropriate supervision and support.

______________________________________________________ ______________________________________________________ ______________________________________________________

YOUTH PRINTED NAME: ________________________________________________ SIGNED: X______________________________________ (Participant under 18 years old)

Date: _______________________

IMMUNIZATION HISTORY (This must be completed) Are your child’s immunizations up to date? ■ YES ■ NO

Date of most recent tetanus shot: (month/year) _______/_______

RELEASE AUTHORIZATION I give permission to the following individual(s) to pick up my child at the conclusion of this 4-H event: Name(s): ________________________________, ________________________________, _______________________________ Sign below at time of pick up (Receiving person must be pre-listed above): Name (print): _______________________________

Signature: _______________________________ Date: ________________

www.ext.vt.edu

*

Publication 4H-164NP

www.ext.vt.edu

*18 U.S.C. 707

Produced by Communications and Marketing, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, 2016

Virginia Cooperative Extension programs and employment are open to all, regardless of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, veteran status, or any other basis protected by law. An equal opportunity/affirmative action employer. Issued in furtherance of Cooperative Extension work, Virginia Polytechnic Institute and State University, Virginia State University, and the U.S. Department of Agriculture cooperating. Edwin J. Jones, Director, Virginia Cooperative Extension, Virginia Tech, Blacksburg; M. Ray McKinnie, Interim Administrator, 1890 Extension Program, Virginia State University, Petersburg. VT/0416/4H-609NP

www.ext.vt.edu

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