( ) Jr. 12 and under ( ) Sr. 13 and over

Name_____________________________Grade(98/99)____Age(!/!/99)_____Phone___________

Mailing Address___________________________________________City____________Zip_____

4-H Club__________________________________________________________

Name of ( )Horse ( ) Pony________________________________________Mare( ) Gelding( )

 Name of Second ( )Horse ( ) Pony________________________________________Mare( ) Gelding( )

Check each class you wish to enter and the correct level for each class. Fitting and Showing is Required.
 

Thursday - July 15  Classes start at 9 am Fitting and Showing ( ) BEG ( ) INT ( ) ADV Trail ( ) WALK/TROT ( ) BEG ( ) INT ( ) ADV  Green Horse ( ) BEG ( ) INT ( ) ADV  Versatility ( ) WALK/TROT ( ) BEG ( ) INT ( ) ADV  Musical Ride ( ) WALK/TROT ( ) BEG ( ) INT ( ) ADV Costume ( ) YES THURSDAY EVENING POTLUCK AND BBQ

Friday - July 16  Classes start at 9 am   Stock Seat Eq. (  )WALK/TROT ( ) BEG ( ) INT ( ) ADV ( )MEDALS  Western Bareback Eq. ( )WALK/TROT ( ) BEG ( ) INT ( ) ADV Western Pleasure ( ) WALK/TROT ( ) BEG ( ) INT ( ) ADV  Western Reining ( ) WALK/TROT ( )BEG ( ) INT ( ) ADV Western Riding ( ) WALK/TROT ( ) BEG ( ) INT ( ) ADV

Saturday - July 17  Classes start at 9 am   Huntseat Eq. ( ) WALK/TROT ( ) BEG ( ) INT (.) ADV ( ) MEDALS  English Bareback ( ) WALK/TROT ( ) BEG ( ) INT (. ) ADV  Saddleseat Eq. ( ) WALK/TROT ( ) BEG ( ) INT (. ) ADV  English Pleasure ( ) WALK/TROT ( ) BEG ( ) INT (. ) ADV Hunter Hack ( )BEG ( ) INT ( ) ADV  Huntseat Over Fences ( ) BEG ( ) INT ( ) ADV  Hunter Warmup ( ) BEG ( ) INT ( ) ADV Low Jumper (  ) BEG ( ) INT ( ) ADV IT IS HIGHLY RECOMMENDED THAT YOU RIDE HUNTSEAT FOR AT LEAST ONE YEAR BEFORE SIGNING UP FOR JUMPING CLASSES.

Sunday - July 18  Classes start at 11 am   Barrels (  ) Poles (  ) Arena Race (  ) Key Hole (  ) YOU MUST RIDE YOUR HORSE IN AN EQUITATION CLASS BEFORE RIDING IT IN GYMKHANA ( REINING AND RIDING DO QUALIFY)

Show Fees Class Fee Flat Rate $15	$15 times horses shown	$15.00
Refundable Stall Cleaning Fee $ 10 $10 will be refunded if your stall is cleaned at the end of the show.	$10 for each stall	________
Stall fees of $4 per night per horse	$4 times nights times horses stalled	________
	TOTAL ENCLOSED	________
E.I.A. enclosed		(   ) Yes
Form signed by Leader, Exhibitor and Parent		(   ) Yes

Leader Verification

I hereby witness this 4-H member has been responsible for the care and training of the horse(s) entered for at least 60 days, is a member in good standing of the 4-H program and is qualified for all classes entered. Signature of Leader_____________________________________Date____________

Exhibitor

I agree to abide by all the rules and regulations set forth by the Alaska State Fair , France Equestrian Center and A.C.E. 4-H. Signature of Exhibitor _____________________________________Date ____________ ------------------------------------------------------------------------------------------------------------------

Parent Release

I understand that I, and I alone, am responsible for the care of my child while he/she is involved in the Mat-Su District sponsored horse show. I hereby release the Alaska Cooperative Extension, show coordinators, and the Alaska State Fair, Inc. from any and all responsibility/liability for any accidents or injury to horse/pony, rider, exhibitor, spectator or property that may incur in connection with this show. I give permission for my child to be treated by a qualified physician in case of accident or injury. I further agree to be financially responsible for any fees which may be incurred should the veterinarian need to be summoned to treat my child's horse/pony. Signature of Parent / Guardian_________________________________Date___________