Stark County

2012

Attention Applicant:

Please complete the following forms and return to Pam Baad by June 1st, 2012.

Enclosed Forms:

2012 State Qualifier Entry Form

2012 State Qualifier Liability Form

*Please include a copy of horse’s current shot records*

Stark County applicants must have completed the 2011 Skillathon and showed at the 2011 Fair Show, unless they are first year members.

Applicants will be checked by the Executive Horse Committee and those applicants who are denied will be notified by June 8th by a letter of explanation.

** All information must be filled out or your application may be rejected.**

You are expected and responsible for understanding the 2012 PAS (Performance Against Standards) rules, the 2012 Stark County Horse Committee Rules, and the Uniform State Rule Book for 4-H Horse Shows.

*Mail forms to &/or any Questions:

Pam Baad

Stark Co. Jr. Fair Coordinator

P.O. Box 80279

Canton, Ohio 44708

Office: 330-455-7856

You will receive a show bill and your class information As Soon As Possible after the entry deadline.

Stark County PAS State Qualifier will be:

Saturday, June 16th, 2012

At the Massillon Saddle Club Show Grounds

NO CHANGES WILL BE MADE ON THE DAY OF THE STATE QUALIFIER SHOW JUNE 16th, 2012. UNLESS: THERE IS AN INJURY TO EITHER HORSE OR RIDER OR BOTH, OR IF THERE IS A SAFETY ISSUE! This discretion will be left up to the Stark County Executive Horse Committee and the State Qualifier Judge.

*You MUST BE at the Intermediate or Advanced level to compete!

Payments are to be made the day of the show:

Stark Co. Members- $20.00

Out Of County- $30.00

Forms submitted after June 1st- add additional $10.00 fee

(Late entrants are restricted to classes scheduled as of June 1st)

Grounds Fee- $4.00

Make checks payable to: Stark County 4-H Horse Committee

**GOOD LUCK**

The Stark County Horse Committee

2012 Stark County 4-H

State Qualifier Form

I would like to compete in the State Qualifier Show to be held Saturday, June 16th, 2012, in the following 4 classes. Should I qualify in two classes, I agree to show in the same corresponding classes at the Ohio State Fair. I understand that I must use my 2012 Project Animal for both the State Qualifier and the State Fair.

Member’s Name: ______

Club Name: ______

Member’s Address: ______

City: ____________

County: ______

State: Ohio E-mail Address: ______

Zip Code: ______

Phone #: ______

Member’s Birth Date: ______

Member’s Age (4-H Age): ______

Horse’s Name: ______

Horse or Pony: ______If Pony, Height: ______

Advisor’s Name:______

Advisor’s Signature:______

Our/My Son/Daughter Has/Have My/Our permission to compete in the Ohio State Fair State Qualifier. We/I will assume responsibility of the State Fair Trip should He/She should qualify, Including: Travel Expenses, Transportation, Food, Lodging, and Chaperoning. We/I also agree to abide by all Rules, printed in the Uniform Rules for 4-H Horse Shows (The State Rule Book), Stark County 4-H Horse Committee Rules, and the 2012 PAS (Performance Against Standards) Rules.

Parent or Guardian Signature: ______

Date: ______

4-H Member Signature: ______

-- Attention!! Even if member is 18yrs. of age, a parent or guardian signature is needed by 4-H Rules.

Stark County 4-H Horse Committee Statement

of Responsibility for State Qualifying Show

Child’s Name: ______

Club Name: ______

Date: ______

While at the 2012 State Qualifier Show, I will see that my child adheres to all of the rules of the Stark County 4-H Horse Committee, the PAS Rules, the rules of Massillon Saddle Club & their Show grounds, and the State 4-H Uniform Rule Book.

Signature of Parent/Guardian: ______

OR

Since I am unable to come to the 2012 State Qualifier Show:

Name: ______of the ______

4-H Club will have responsibility of seeing that My/Our child adheres to all of the rules of the Stark County 4-H Horse Committee, the PAS Rules, the rules of Massillon Saddle Club & their Show grounds, and the State 4-H Uniform Rule Book. If necessary, I/We may be reached at the following:

Phone Number: ______

Signature of Adult accepting Responsibility of Child:

______

Signature of Parent/ Guardian:

______

2012 Classes For State Qualifier- Choose Four (4)

_____ Showmanship- Western _____ Draft Horse Driving

_____ Showmanship- English _____ Light Horse Driving

_____ Showmanship- Draft _____ Draft Pony Driving

_____ English Equitation-Hunter- Hunt Seat _____ Ground Roping

_____ English Equitation- Saddle Seat _____ Cloverleaf Barrels

_____ Working Hunter Under Saddle- Pleasure _____ Cones & Barrels

_____ English Pleasure- Saddle Seat _____ Pole Bending

_____ Hunter Hack _____ Speed & Control

_____ Working Hunter Over Fences

_____ Hunt Seat Equitation Over Fences

_____ Easy Gaited Equitation

_____ Pleasure- Easy Gaited

_____ Horsemanship- Western

_____ Western Pleasure

_____ Western Riding

_____ Western Reining- Jr. (Pattern B)

_____ Western Reining- Sr. (Pattern C)

_____ Trail

_____ In Hand Trail

_____Driving Reinsmanship (Draft or Light)

_____ Pleasure Driving

Check List:

Member’s Name: ______

Club Name: ______

Division: Intermediate: ______Advanced: ______

Age (4-H): ______

Phone #: _____ - ______- ______

E-mail Address: ______

Advisor’s Name: ______

Are the following Forms Enclosed & Filled Out?!

2012 State Qualifier Form: ____ with signatures

2012 State Qualifier Responsibility Form: _____ with parent/guardian signature and if applicable, signature of adult taking responsibility: _____

2012 Class Form List: _____ with 4 classes checked

Copy of 2012 Shot Records Enclosed: ______

Send entry form to and if any questions feel free to contact

Pam Baad,

Stark County Jr. Fair Coordinator

P.O. Box 80279

Canton, Ohio 44708

!!! GOOD LUCK !!!