Teen Counselor Horse Camp

Skamania County 4-H Teen Counselor Horse Camp June 30 th July 1 st, 2012 What and Who: Teen Counselor Horse Camp is for teens who want to volunteer at the regular Horse Camp (held July 12-15) as camp helpers or leaders of groups of campers. A teen must be at least 14 years old and have completed 9 th grade and be available to volunteer the dates of regular Horse Camp (July 12-15.). The two-day Teen Camp will teach the basics of leadership and go over the responsibilities the teen counselors will have at Horse Camp. In addition, there will be fun activities with the counselors horses. Where and When: The Teen Camp is held at the Skamania County fairgrounds from June 30 July 1, 2012. It begins with haul-in of horses at the east end of the horse barn at 9 a.m. on Saturday and ends in the evening after clean-up on Friday. (Haul-in is possible Friday evening with prior approval contact Kay Day.) Nighttime Accommodations and Meals: At the end of each day, teens will camp near the horse barn with an adult Camp leader. Counselors will need to bring sleeping bags and tents. All meals will be provided by the Teen Horse Camp. Cost: The cost for Teen Counselor Horse Camp is free this year to counselors! Forms: If your teen will be attending the Teen Counselor Horse Camp, attached are several forms that need to be filled out, signed and sent to the address below by June 18. These forms are attached and listed below. Teen Counselor Horse Camp Registration Skamania County WSU 4-H Rules, Behavior, Conduct and Informed Acknowledgement of Camp Hazards and Risks Member s Health and WA State 4-H No-Fault and Parental Consent and Release Important Information: Please read the information in the attached pages if your child will be attending Teen Counselor Horse Camp. Emergencies Counselors must leave their cell phones (and any other electronic devices) at their campsites during camp hours. If there is an emergency please call the 24 hour emergency number 360-713-2339. Where to Send Forms and Ask Questions: Send Forms by June 18 to: Martha Thomas 451 Cannavina Rd. Carson, WA 98610 509-427-8793 marthe_thomas@yahoo.com Ask Questions of: Kay Day 360-713-2339 daystri@aol.com

Arena Safety Staying safe while riding in the arena requires good manners. Good manners also keep your fellow riders from getting angry with you. The rules vary at different barns. Common rules that need to be followed at Horse Camp and Fair are: 1. Riders proceeding at the faster pace have the right of way on the rail. If several people are cantering or trotting around the arena and you want to walk, you should walk inside the track, not on the rail, which blocks the pace of the others. 2. Don t tailgate. Riding on someone else s tail can be disconcerting to the rider getting tailgated, especially if it causes his or her horse to act up. In general, stay away from other horses. Leave at least one horse s length between you and another rider. 3. Allow ample room when passing and crossing. When passing the horse in front of you, allow plenty of clearance, at least the width of two horses as you pull out and around. Get well in front of the horse, at least two horses lengths, before moving back onto the rail. Any time you are moving onto the rail leave two horses lengths between you and the rider behind you. 4. Don t stop dead in your tracks. Unless you have an emergency, avoid stopping suddenly when other riders are behind you. Pull off the rail if you have to halt, it is better than causing the riders behind you to pile up, which interrupts the flow and interferes with your fellow riders. 5. Be quick to apologize. Despite your best efforts your horse may occasionally stop and cause a pile up. Or you may mean to provide more clearance when passing but miscalculate and cut someone off. Apologize to the other rider or riders, as appropriate. Just showing that you mean to be courteous goes a long way toward keeping the riding experience pleasant for everyone. 6. Please do not mount or dismount on the rail. Go to the middle if you need help or to adjust tack, etc. 7. Majority rules. When most of the people in the arena are jumping, for example, you can t come in and walk your horse around the ring if you will be in the way. Always ask. 8. No lunging while people are riding. No riding in bareback pads or halters. No racing. 9. An adult must be supervising anytime a rider is in the arena.

Horse Camp Packing List For your Horse: Hay bag (no nets please) or hay can go on the ground Two water buckets Electrolytes (paste or powder) Feed pan if you grain your horse Salt block Enough feed and grain for the days you will be at camp Grooming supplies Fly spray Tack for riding Manure fork and wheelbarrow For You: Helmet (REQUIRED!) Sleeping bag and pillow Towel and toiletries (showers are available) Boots and clothing for warm and cold Raincoat if you have one Fly and mosquito repellent Sunscreen Water bottle During camp hours all electronic devices (cell phone, I-pods, etc.) need to remain in your tent or camper. Campers are not allowed to carry these devices with them. An emergency number at camp is provided if a parent needs to contact his/her child during camp hours.

WRITTEN NOTICE OF PASSIVE CONSENT 4-H ACTIVITY EVALUATION (For youth participants under 18 years of age) As a participant in the 2012 Skamania County Teen Counselor Horse Camp your son or daughter may be asked to help with the evaluation of the program. At the end of each program or program year, we conduct an evaluation to tell us how well the program is working. Your son or daughter may be asked to complete a written survey about what he or she may have learned from participating in the program. We estimate that it will take the youth participant approximately 10 minutes to complete the survey. Youths are not required to participate in the evaluation. If your son or daughter decides that he or she does not wish to participate, it will not affect his or her participation in this or future WSU Cooperative Extension programs. If your son or daughter does not want to answer some questions on the survey, that is okay. The survey responses will be anonymous, and your son s or daughter s responses will not be identified in any way. If you do not want your son or daughter to participate in the evaluation of the 2012 Skamania County 4-H Horse Camp please contact the Extension Office at 509-427-3932 before your child begins attending the program. If you have any questions about the evaluation, you can contact Dr. Mary Y. Deen at (509) 662-4730 or the Washington State University Institutional Review Board at (509) 335-9661.

REGISTRATION TEEN COUNSELOR 2012 HORSE CAMP June 30 TH - July 1 st Name of Camper Address Phone Number E-mail 4-H Club Leader Name Years Riding Years in 4-H Jr. Int. Sr. Date of Birth Grade finished by date of camp Meals: Please let us know if your teen has any food allergies/sensitivities or needs a vegetarian or vegan meal: Name of Parent or Guardian Address Phone Number E-mail Parent or Guardian Signature Please send all forms before June 18 to: Martha Thomas 451 Cannavina Rd. Carson, WA 98610 (509) 427-8793 or marthe_thomas@yahoo.com Be sure you have enclosed the following forms: Horse Camp Registration Skamania County WSU 4-H Rules, Behavior, Conduct and Informed Acknowledgement of Camp Hazards and Risks Member s Health and WA State 4-H No-Fault and Parental Consent and Release

Skamania County WSU 4-H Rules, Behavior, Conduct and Informed Acknowledgement of Camp Hazards and Risks Camp Name: Skamania County 4-H Teen Counselor Horse Camp Date: June 30 July 1, 2012 Rules are made not to restrict people from having fun, but to assure that everyone can have fun and be safe, too. The warnings are being stated to make you aware of the risks involved in being out of doors and at camp. The following rules are to be read to your child before attending Camp and then signed by both parent/guardian and camper. 1. Campers are expected to remain on the camp grounds unless on a supervised outing. 2. Campers are to follow all camp and facility rules. 3. Campers will remain with their group unless they are involved in a supervised activity. Campers must obtain permission from their counselor before leaving the group and must use the buddy system. This if for the protection of the camper and lets the counselor know where his or her campers are at all times. 4. Campers are not allowed to have matches or lighters. Fire is a very real hazard in the Pacific Northwest. 5. Campers will be sent home if found with cigarettes, alcohol, chewing tobacco, illegal substances, or fireworks. 6. Campers will not deface any camp property. If the 4-H group is fined for a camper s graffiti, the fine will forwarded to the offender s parent/guardian. 7. Campers will not use profanity. 8. Fighting will not be allowed. 9. If a camper brings valuables it will be at his or her own risk. The camp will not be responsible for lost or stolen items. 10. All campers must have permission from the camp director to use the camp phone. 11. It is the responsibility of every camper s parent/guardian to provide for the campers own accident and health coverage beyond the limits of the camp coverage. Northwest Washington 4-H Youth Camp provides limited insurance coverage up to $3, ooo for accidents and up to $1,000 for illness incurred while attending the camp. 12. I agree that as consideration for allowing my child to participate in camp, I will not hold Washington State University or any part of it nor the State of Washington, or any of its officers, employees, and agents, responsible for what happens to my child at the camp. I accept full responsibility for any injuries that may occur as a result of my child s participation in camp. 13. Campers families are welcome to visit. We welcome volunteers to help during the day. Jr. members MUST have a parent or guardian present at night. 14. If a camper s behavior is deemed unacceptable, the parent or guardian will be called and asked to pick up the child. No refunds will be given if a camper is sent home. WARNING: The purpose of this warning is to advise you about the dangers associated with your voluntary participation in 4-H camp. Participation in 4-H camp may involve the possibility of injury or the loss of life to you or others. Any injury can impair your physical or mental health. This could affect your future, including the ability to make a living, engage in business, participate in social and recreational activities, and to enjoy your life. This warning does not list everything. As a parent/guardian, it is your right to inquire about all potential risks. You must fill out the 4-H camp health history form completely and honestly so that we are aware of any relevant medical conditions. All activities must be attended. If there is a medical reason for not participating in a class or camp event other arrangements will be made at the class. You should never participate in anything that you do not regard as safe. I HAVE READ AND UNDERSTAND THIS DOCUMENT, HAVE CONSIDRED IT CAREFULLY AND AGREE TO IT. CAMPER S SIGNATURE PARENT S SIGNATURE DATE DATE

MEMBERS HEALTH FORM MEDICAL HISTORY (Each delegate must complete and return to 4-H event coordinators.) 1. Do you have any physical complaints or chronic illness at this time? Yes No If yes please explain 2. Are you under the care of a physician or practitioner of any sort? Yes No If yes please explain 3. Are you taking medicines of any type? Yes No If yes, what? In what dosage? Are you on a special diet? Yes No If yes, what kind? 4. Do you have or have you ever had: a) Diabetes? Yes No If yes are you taking insulin? How much? What kind? b) Asthma? Yes No If yes, do you carry an inhaler? c) Allergy? Yes No If yes, to what? d) Any other disorder? 5. Physician s Name Phone no. Insurance Company Policy Number WASHINGTON STATE 4-H NO-FAULT FORM PARENTAL CONSENT AND RELEASE FORM PARTICIPANT Last Name First Name PHONE NUMBER: ADDRESS: CITY/STATE/ZIP CODE: 4-H CLUB OR GROUP: COUNTY: 4-H ACTIVITY: Skamania County Teen Counselor Horse Camp As parent/legal guardian of the above individual, I hereby give my consent for the above named person to attend the 4-H event listed above. I also hereby waive and forever discharge claims for damages which the above listed individual, their heirs, executors and administrators may have or accrue against Washington State University Cooperative Extension, their representatives, agents, and accompanying 4-H program leaders, arising from any injuries, physical or mental, suffered in connection with 4-H sponsored activities. In case of emergency, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give permission to the physician selected by the state delegation to hospitalize and secure proper treatment (including surgery) for my child. I understand and give my consent that any photos taken of my child s participation in a 4-H event may be used in future WSU Cooperative Extension publications or printed promotional materials. I have read, understand, and agree to the above listed statement and do sign this agreement of my own free will. PARENT/GUARDIAN SIGNATURE DATE ADDRESS CITY, STATE ZIP CODE PHONE NO.