2011-2012

PIMA COUNTY 4-H HORSE PROJECT REGISTRATION/LEASE

(To be filled out by every horse member)

DATE:__________________ CLUB NAME:_____________________________

NAME:_______________________ BIRTHDATE:______________________________

ADDRESS:____________________CITY:______________STATE:______ZIP_______

JR (9-13YRS) SR (14-19YRS) YEARS IN HORSE PROJECT:________

HORSE LEASED? YES NO (If yes, please fill out reverse side)

CIRCLE YOUR HORSE SHOW CLASSIFICATION (LEVEL) IN EACH AREA:

ENGLISH L W/T B I A WESTERN L W/T B I A

OVER FENCE N I A GYMKHANA L W/T B I A

SORTING B I A ROPING B I A

ENGLISH OVER FENCES, SORTING AND ROPING ALL NEED QUALIFING PAPERS TO BE FILLED

OUT AND TURNED IN TO THE SHOW SECRETARY.

HORSE TO BE USED:

HORSES NAME; MARE/GELDING BREED DATE PURCHASED OR LEASED

Registered/Barn e nam

I give my written consent for my child to use the horse(s) listed above in the Pima County 4-H Horse Project.

nature ______ ______ ______ ______ ______ ____ I agree to the use of the horse(s), listed and described above, in the Pima County 4-H Horse Project.

er Signatu re_____ ______ ______ ______ ______ ____ I am aware that the horse(s) listed and described above, is used/leased for the use in the

Pima County 4-H Horse project by the member named above.

LEADERS SIGNATURE___________________________ LEADERS PHONE # _______________________

FALL Registration/Lease Deadline: OCTOBER 15

SPRING Registration/Lease Deadline: FEBRUARY 15

When registration is complete and signed, please return to:

Sue Frey, 11721 N. Edi Place, Oro Valley, AZ, 85737-9571

LEASING INFORMATION:

HORSE OWNER’S NAME_______________________________________________

HORSE OWNER’S ADDRESS_____________________________________________

CITY________________ STATE_____________ ZIP___________________________

PHONE__________________________________

HORSE LOCATION______________________________________________________

I give my written consent for my horse, listed and described on the previous page to be used by the member,

listed on the previous page as a Pima County 4-H Project horse.

HORSE OWNER’S SIGNATURE____________________________________________

DATE_________________