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Leon & Madison County 4-H Horse Riding Group Interest Form

If you are interested in the Leon County 4-H & Madison County 4-H Horse Riding Group Please Fill Out this Form. Included in this form: Basic Information, 4-H membership Information, Emergency Contacts, Option to Upload Coggins, & More. For more information visit: Leon County 4-H- https://leon.agrilife.org/horse/ Texas 4-H- https://texas4-h.tamu.edu/projects/horse/ 4-H Member & Volunteer Enrollment- https://v2.4honline.com/

4-H Member #1 Name(Required)

First Last

Please list the name of Leon County 4-H or Madison County 4-H Member. Please ONLY list FAMILY MEMBERS. Do a SEPERATE Form for Friends, etc...

List Grade Level of 4-H Member #1(Required)

4-H Member #2 Name

First Last

Please list the name of Leon County 4-H or Madison County 4-H Member. Please ONLY list FAMILY MEMBERS. Do a SEPERATE Form for Friends, etc...

List Grade Level of 4-H Member #2

4-H Member #3 Name

First Last

Please list the name of Leon County 4-H or Madison County 4-H Member. Please ONLY list FAMILY MEMBERS. Do a SEPERATE Form for Friends, etc...

List Grade Level of 4-H Member #3

4-H Member #4 Name

First Last

Please list the name of Leon County 4-H or Madison County 4-H Member. Please ONLY list FAMILY MEMBERS. Do a SEPERATE Form for Friends, etc...

List Grade Level of 4-H Member #4

4-H Member #5 Name

First Last

Please list the name of Leon County 4-H or Madison County 4-H Member. Please ONLY list FAMILY MEMBERS. Do a SEPERATE Form for Friends, etc...

List Grade Level of 4-H Member #5

Click the Appropriate County 4-H Program for your families' 4-H membership (Leon or Madison)(Required)

Click the Appropriate County 4-H Program your family is a member of (Leon or Madison). You MUST be a member of either Leon County 4-H or Madison County 4-H to ride/participate. 4-H membership is $25 from September 1-October 31. After that, it increases to $30/member. Adults that will be riding or helping MUST also be registered as 4-H volunteers.

Family Email Address(Required)

Parent/Guardian #1 Cell Phone Number(Required)

Please list ONLY if you are okay with receiving text messages about 4-H riding practices, etc...

Parent/Guardian #2 Cell Phone Number

Please list ONLY if you are okay with receiving text messages about 4-H riding practices, etc...

Adult Volunteer Information

Any adults that plan on riding or helping youth MUST be enrolled as 4-H volunteers either with Leon County 4-H or Madison County 4-H. This can be done online. There are 2 trainings and a back ground check as well online. This covers all adults with Texas 4-H Insurance. Please contact Leon County or Madison County if you have any questions with this process.

Adult Volunteer Name

First Last

Adult Volunteer Phone Number

Adult Volunteer Name

First Last

Adult Volunteer Phone Number

Adult Volunteer Name

First Last

Adult Volunteer Phone Number

Emergency Contact Information

In case of an emergency please fill this information out. This will NOT be shared with anyone.

Emergency Contact Name(Required)

First Last

Emergency Contact Phone Number(Required)

Emergency Contact Phone Number #2

Emergency Contact Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Horse Information

The following are questions about the horse you will be bringing to the 4-H riding group. If you do NOT have a horse but would like to come and watch you are more than welcome. If you are borrowing a horse please list that information.

Horse #1 Information(Required)

Upload Coggins for Horse #1

Max. file size: 49 MB.

A negative Coggins test (EIA), administered by a licensed veterinarian within the last 12 months, is required for all equine entering the Leon County Expo grounds. You may bring a copy to the riding practice as well if you cannot upload. We can scan it/take a picture of it at practice.

Horse #2 Information

Upload Coggins for Horse #2

Max. file size: 49 MB.

A negative Coggins test (EIA), administered by a licensed veterinarian within the last 12 months, is required for all equine entering the Leon County Expo grounds. You may bring a copy to the riding practice as well if you cannot upload. We can scan it/take a picture of it at practice.

Horse #3 Information

Upload Coggins for Horse #3

Max. file size: 49 MB.

A negative Coggins test (EIA), administered by a licensed veterinarian within the last 12 months, is required for all equine entering the Leon County Expo grounds. You may bring a copy to the riding practice as well if you cannot upload. We can scan it/take a picture of it at practice.

Horse #4 Information

Upload Coggins for Horse #4

Max. file size: 49 MB.

A negative Coggins test (EIA), administered by a licensed veterinarian within the last 12 months, is required for all equine entering the Leon County Expo grounds. You may bring a copy to the riding practice as well if you cannot upload. We can scan it/take a picture of it at practice.

Horse #5 Information

Upload Coggins for Horse #5

Max. file size: 49 MB.

A negative Coggins test (EIA), administered by a licensed veterinarian within the last 12 months, is required for all equine entering the Leon County Expo grounds. You may bring a copy to the riding practice as well if you cannot upload. We can scan it/take a picture of it at practice.

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