ENTRY FORM Checks payable to: Britannia Farm 26901 West Brooks Road Waller, TX 77484
November 24 & 25, 2012
OWNER
COGGINS Acc. #: _________________ Date: _________ Lab:______________
D
E
F
G
______STALLS @ $50.00 ______DAY STALL @ $40/day
___________________________________
____________________________ ______ NON—SHOWING FEE @ $30/day
Name
Name
___________________________________
___________________________________
Address
Address
___________________________________
___________________________________ GHHJA N/M FEE @ $10
City, State, Zip
City, State, Zip
H
Age
I
J
K
L
M
N
RIDER GHHJA #: ___________________
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
____GROUND FEE @ $20/day OFFICE FEE @ $10 per entry
CLASS FEES
R
TOTAL
S
Sch Jr/Ad Open Ity Bity Jmpr Jmpr Jmpr Jmpr
SAT
LATE FEE EARLY ARRIVALS @ $25.00
Email address required: ____________________________________
MARK DIVISIONS ENTERED FOR EACH DAY C
______STALLS @ $70.00
RIDER
Horse GHHJA #: ___________________ OWNER GHHJA #: _________________
B
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 Email entries to mfmoffett@hughes.net
NAME OF HORSE
A
NUMBER (office use only)
Fall Harvest Horse Show & Fall Finale Horse Show
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., ROB MOYAR, LUCIA HANSEN, 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, ROB MOYAR, LUCIA HANSEN, GREAT SOUTHWEST EQUESTRIAN CENTER L.P.. 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:
PLEASE STABLE WITH: Notice: Stalls will not be held unless check accompanies entry. Trainer’s Name ____________________________________________________ Trainer’s Signature __________________________________________________ Trainer’s GHHJA Number ____________________________________________
MUST be signed if rider is under 18 years of age. Numbers will not be issued until this form is signed!
Where a minor exhibitor has no trainer, parent or guardian must sign and assume responsibility.
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 thereunder for the participation of said minor.
Exhibitor Signature _________________________________________________
_____________________________________________________________ Signature of Parent/Guardian/Trainer
Emergency Contact / Cell Phone No.___________________________
(Must be signed by exhibitor, owner or his agent.)