Office Use Only
Name of Horse or Pony
Gr Year
Sm Junior
Sm Pony
AA 18-35
High Pre Green
Lg Junior
Med Pony
AA 36-49
2nd Year Green
Baby Green
Children's 14 & U
Large Pony
AA 50 & O
Performance 3'6"
AO 36 +
Children's 15-17
S/M Green Pony
Mod. Child
Performance 3'3"
AO 18-35
Children's Htr. Pony
Large Green Pony
AO 3'3" - 18-35
Jr/Am Modified
Hopeful
Limit
1st Year Green
Low Pre Green
USHJA Horse Reg #
Make checks payable (in US Funds) and mail to: Southbound Show Management Inc. 785 W. Jeter Road Argyle, TX 76226 940-240-1207 phone
THJA #
Equitation, Individual Hunter & Opportunity Classes by Rider
HUNTER DIVISIONS - please indicate Rider 1 or Rider 2 High Performance
Entries Close: September 7, 2012
Southwest Showdown Horse Show Katy, TX September 20-23, 2012
Only ONE HORSE per entry form. PLEASE type or print clearly. Please indicate which week!
Rider 1
Rider 2
Color
Sex
Individual Jumper Classes by Rider Rider 1
Height
JUMPER DIVISIONS Indicate Rider 1 or Rider 2
Rider 2
TJ 0.85
Low Child/Ad
TJ 0.95
High Children
TJ 1.00
High Adult
TJ 1.15
Low Jr/AO
TJ 1.20
High Jr/AO
Open1.30
Open1.40
Mod. Adult Short or Long Stirrup
Low Hunter
AO 3'3" - 36 +
Foaled
Federation Entry Agreement I have read the United States Equestrian Federation, Inc. (the "Federation") Entry Agreement (GR906.4) as printed in the Prize List for Britannia Farm Winter Horse Show Ground Fee $50.00 per horse = ("Competition") and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, the Prize List, and local rules of Office Fee = the competition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against the Federation must be brought in New York State. A Negative Coggins Test dated within one year Release, Assumption of Risk, Waiver and Indemnification 30 amp & 50 amp RV @ $225.00 = of the show must accompany this entry. This document waives important legal rights. Read it carefully before signing. Stall Fee Permanent stalls @ $180.00 = I AGREE in consideration for my participation in this Competition to the following: I AGREE that the "Federation" and "Competition" as used above includes all of their officials, officers, directors, employees, agents, personnel, volunteers and affiliated organizations. Jumper Nomination @$150.00 = I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death ("Harm"). Non Showing Horse $100.00 = I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or the Competition. USEF Drug Fee @$16 (USEF $8; D/M $8) = I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm USHJA Zone Support Fee = caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and, if applicable, EV114 and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child's participation and AGREE THJA Non-Member Fee @$10.00 = to all of the above provisions and AGREE to assume all of the obligations of this Release on the child's behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition. I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form. BY SIGNING BELOW, I AGREE to be bound by all applicable USEF NM Fee: ($30) Federation Rules and all terms and provisions of this entry blank and all terms and provisions of this Prize List. If I am signing and submitting this Agreement electronically, I acknowledge that my electronic signature shall have the same validity, Owner Rider Trainer force and effect as if I affixed my signature by my own hand. BOD 1/23/11 Effective 12/1/11
Owner / Agent Signature:
Trainer Signature:
Name USEF #
USEF #
Owner
Name
Name THJA #
USHJA NM Fee: $30
Rider #1 Signature:
THJA #
THJA # Birthdate
Address
ASPCA #
City, State, Zip
City, State, Zip
Address
Phone
Phone
City, State, Zip
Fax
Fax
Rider #2 Signature:
Cell
Cell
Name
USEF #
THJA #
SS #
SS #
ASPCA #
Birthdate
Name SS #
Coach Sig.
City, State, Zip Is Rider / Driver / Vaulter a US Citizen? Write Yes or No
Name
Parent/Guardian Emergency Contact
Phone
Name
Email Address: (required)
Amount Enclosed: Stable With
Address
Sig.
Late Fee (postmarked after Sept 7) $50.00=
Stalls will not be reserved without payment!
City, State, Zip
Name
Address
Trainer
Total Due =
USEF #
Address
Alternate Payee
Rider
I agree neither GSEC, nor the Show Committee, nor Patrick Rodes, Southbound Show Management Inc., Pauline Cook dba Britannia Farm, nor the officials and/or staff of the show will be responsible for any accident, damage, loss or injury to count, owner, rider or other persons or property. It will be the condition of entry that each exhibitor shall hold the horse show and its management blameless for any loss or accident to any animal, person or property that may occur from sickness, fire and otherwise at this show. Under Texas law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities.
Failure to present proper USEF/USHJA membership cards will result in non-member fees being charged.