RIDER’S FILE INFORMATION CHECKLIST 4H MEMBER FORM (ALL

CONFIDENTIAL RIDING APPLICATION AND MEDICAL HISTORY FORM ►RIDER’S NAME
RIDER’S FILE INFORMATION CHECKLIST 4H MEMBER FORM (ALL
SKATEBOARDING COMPETITION WAIVER AND RELEASE OF LIABILITY FORM RIDER’S

Rider’s File Information Checklist:

____ 4-H Member Form (All sections)

____ Rider Registration and Emergency Treatment Form & Informed Consent and Liability Form

____ Photo Release Form

____ Physician’s Referral Form

____ Down Syndrome Rider Evaluation

____ Parent Application Form

____ Physical or Occupational Therapist Assessment

____ Teacher Assessment(s)

____ Speech Pathologist Assessment

Proof of a diagnostic negative x-ray for ADC (Alanto-axial Dislocation Condition) is required for all Down’s Syndrome rider in the Michigan 4-H PEP programs. Down’s Syndrome riders currently enrolled in programs who have not already done so must show proof of an ADC diagnostic negative x-ray prior to continuing riding instruction.

All forms must be renewed annually. Only completed applications will be accepted so be sure to check and complete both sides of the pages.

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