HORSE MANAGEMENT AGREEMENT
Due in the Cass County Extension Office on or Before
May 1 (Firm!)
ABOUT THE EXHIBITOR:
Youth Name:__________________________ Age:_____________
Address:_______________________________________________ Sex:___
4-H Club:______________________ Phone:_________________________
Parents:_______________________________________________________
Horse Loaned or Leased (circle one)
Owner_________________________
Date Lease Period Starts________
Date Lease Period Ends____________
ABOUT THE HORSE:
Name:______________________________________ Sex:______________
Breed:___________________ Registration Number:___________________
Age:________ Size: Weight:_______ Height: ______Hands _____Inches
Brief Description of the Animal: (color, markings, etc.)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Terms of Agreement:
1. Owner agrees to permit Youth to feed, water, and ride animal for
the period of the lease.
2. Owner agrees to supervise proper care and feeding
3. Youth agrees to feed, water, and check health of animal regularly.
4. Member shall keep feed record and cost of other items in caring
for the project.
5. Member agrees to exhibit horse or pony in county horse show.
6. Member assumes no responsibility for death of animal should it
occur.
YOUTH
SIGNATURE___________________________Date:___________
PARENT’S
SIGNATURE:___________________________Date:___________
4-H LEADER
SIGNATURE:___________________________Date:___________
LESSOR’S
SIGNATURE:___________________________Date:___________
Attach Color Photo of each side of animal taken AFTER
January 1st of Current 4-H Year Below!
]]
SIDE 1
SIDE 2
.
Illinois 4-H Certificate of Ownership
I certify that I own the horse described below and plan to exhibit said horse at the Illinois State Fair Junior
Horse Show.
_________________________________________
Signature of 4-H Member
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I certify that the above statement is correct.
________________________________________
Signature of Parent/Guardian
(If member is under 18 years of age)
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Name of Horse:__________________________________________________________
Description of Horse:
Color:_________________ Height:___________________
Markings:________________________________________
Registration Number:_______________________________
Attach Photo of each side of horse here:
Cass County Junior and 4-H Horse Show
Permission to Participate
The Illinois Equine Liability Act requires sponsors to provide the following warning to
participants:
Warning
Under the Equine Activity Liability Act, each participant who engages in an
equine activity expressly assumes the risks of engaging in and legal
responsibility for injury, loss or damage to person or property resulting from the
risk of equine activities.
As parent or guardian of
, I am aware that
Name of Participant
activities involving horses, ponies and other equines are associated with the following
risks including but not limited to:
1.
2.
3.
4.
5.
the propensity of an equine to behave in ways that may result in injury, harm, or death to
persons on or around them,
the predictability of an equine’s reaction to sounds, sudden movement, and unfamiliar
objects, persons, other animals, or other things,
certain hazards of surface or subsurface conditions,
collisions with other equines or objects,
the potential of a participant to act in a negligent manner that may contribute to injury to
self or others.
I understand that
Cass County Fair
Cass County Fair Association
has taken the steps to make the
safe for participants, the public and their property.
I understand and agree to follow these rules.
___________________________________
Signature of Participant
Date
I understand the risks associated with this event and I give_______________________
permission to participate on July 19, 2011.
Parent/Guardian
Date