Hot Daze Horse Show & Mo Hot Daze Horse Show
ENTRY FORM Checks payable to: Britannia Farm 26901 West Brooks Rd. Waller, TX 77484
NUMBER (office use only)
August 18 & 19, 2012
ENTRY FEES
Entries received after 6 pm Thursday will pay $10 late fee. Mail or fax to 281-578-6651 before 6:00 p.m. Friday. Entries received by 5:00 pm Wednesday receive $10 credit on account
NAME OF HORSE
OWNER
COGGINS Acc. #: _________________ Date: _________ Lab:______________
______STALLS @ $70.00 ______STALLS @ $50.00
RIDER
______DAY STALL @ $40/day
___________________________________
____________________________ ______ NON—SHOWING FEE @ $30/day
Name
Name
___________________________________
___________________________________
Address
Address
___________________________________
___________________________________ OFFICE FEE @ $10 per entry
City, State, Zip
City, State, Zip
Horse GHHJA #: ___________________ OWNER GHHJA #: _________________
Age
B
C
D
E
F
G
______SHAVINGS
GHHJA N/M FEE @ $10
RIDER GHHJA #: ___________________
CLASS FEES LATE FEE
MARK DIVISIONS ENTERED FOR EACH DAY A
____GROUND FEE @ $20/day
H
I
J
K
L
M
N
O
Pre Non Walk Pre Grn Sm Med Lg Limit Jr/Ad Low Opn Sch Beg Nov Grn Pro Trot Beg Grass Pony Pony Pony Hntr Hntr Hntr Hntr Hntr Hntr Hntr
P
Q
R
TOTAL
S
Sch Jr/Ad Open Ity Bity Jmpr Jmpr Jmpr Jmpr
SAT
INDIVIDUAL CLASSES
EQUITATION CLASSES
SAT SUN
SUN THIS ENTRY IS AN AGREEMENT THAT THE PERSON ENTERED, ALONG WITH THE OWNER, LESSEES, TRANER, MANAGER, COACH AND HORSE: (1) THAT EVERY HORSE AND RIDER IS ELIGIBLE AS ENTERED; (2) THAT THE OWNER AND ANY OF HIS/HER REPRESENTATIVES WILL AGREE TO THE FINAL DECISIONS MADE BY THE MANAGEMENT AND HOLD THE COMPETITION OF THE GHHJA, PAULINE COOK; DBA BRITANNIA FARM, GREAT SOUTHWEST EQUESTRIAN CENTER L.P., LUCIA HANSEN, MAURENE MOFFETT, THEIR OFFICIALS, THE MANAGEMENT EMPLOYEES AND AGENTS HARMLESS FOR ANY INJURY OR LOSS SUFFERED DURING OR IN CONJUNCTION WITH THE COMPETITION, WHETHER OR NOT SUCH INJURY OR LOSS RESULTED, DIRECTLY OR INDIRECTLY, FROM THE NEGLIGENT ACTS OR OMISSIONS OF SAID OFFICIALS, EMPLOYEES, AGENTS, THE MANAGEMENT, GHHJA, PAULINE COOK; DBA BRITANNIA FARM, GREAT SOUTHWEST EQUESTRIAN CENTER L.P. LUCIA HANSEN, MAURENE MOFFETT, . WARNING, UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATHOF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.
PERMISSION FOR A MINOR TO SHOW: MUST be signed if rider is under 18 years of age. Numbers will not be issued until this form is signed!
PLEASE STABLE WITH: Notice: Stalls will not be held unless check accompanies entry. Trainer’s Name ____________________________________________________ Trainer’s Signature __________________________________________________ Trainer’s GHHJA Number ____________________________________________ Where a minor exhibitor has no trainer, parent or guardian must sign and assume responsibility.
Exhibitor Signature _________________________________________________ (Must be signed by exhibitor, owner or his agent.)
I hereby consent to the entry of my child _____________________________________ in this show and certify that I have read the foregoing representations and statement, and that I hereby agree and accept responsibility there under for the participation of said minor.
Email Address: (required) ____________________________________
_____________________________________________________________ Signature of Parent/Guardian/Trainer
Emergency Contact / Cell Phone No.___________________________
(Must be filled in by exhibitor or owner)