RIDER NUMBER: _____________
Please Stable With: ___________________
ENTRY FORM
th
(Please use separate entry form for each rider)
THE 2010 NEW HAMPSHIRE EQUITATION & HUNTER FINALS Name of Rider
Age of Junior or A (Adult)
Name of Horse/Pony
Height (Pony)
Friday, October 8 W1. Ticketed 2’3” Warm-up @ $20.00 11:00am – 1:00pm W2. Ticketed 18” Warm-up @ $20.00 1:00pm – 2:00pm 1. Lead Line Pleasure @ $20.00 2. Lead Line Equitation @ $20.00 3. Lead Line Hunter Hack @ $20.00 4. Walk-Trot Pleasure @ $20.00 5. Walk-Trot Equitation @ $20.00 6. Walk-Trot Ground Poles @ $20.00 7. The Stone Pony Junior Equitation Classic @ $40.00 8. The Eaton Berube Adult Equitation Classic @ $40.00 9. $100 18” Optimum Time Jumper @ $40.00 9a. $100 2’3”-2’6” Optimum Time Jumper @ $40.00 10. $300 2’9” Jumper Gala @ $75.00 11. $500 3’-3’3” Jumper Classic @ $75.00
_______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______
th
Signatures on the reverse side indicate that each of us has read and understands the rules and warning on reverse. Signatures required in three (3) places. See back for further signatures. X_______________________ Rider’s Signature
Print Name:________________________
(parent/guardian if under 18; if not available, trainer must sign)
X_______________________
Print Name:________________________
Trainer’s Signature & Farm/Barn
X_______________________
Print Name:________________________
Owner’s/Agent Signature
** ASTM/SEI certified helmets are
ENTRY INSTRUCTIONS required for all riders. Harnesses must 1. Check off or X classes entered be buckled while riding ** 2. Enter entry fees in Fee column 3. Enter stall fees if applicable Stall reservations must be made by October 3, 2010 with Penny Brown E-Mail: rockbottombrowns@aol.com or 603-924-6036 4. Make checks payable to NHHJA SHOW FEES 5. No fax entries will be accepted • Office Fee $20.00 6. Mail to: Penny Brown • Trophy Fee $10.00 203 McCoy Rd. • ____ stalls @ $150 if on/before 10/3 ______ Sharon, NH 03458 • ____ stalls @ $175 if after 10/3 ______ Phone: 603-924-6036 • Post Entry Fee @ $30 after 10/3 ______ • Camper Fee @ $25/night
ENTRIES DUE: OCTOBER 3, 2010 PLEASE SEE REVERSE SIDE FOR SIGNATURES
______
Total Show Fees:_________ Total Class Fees:_________ GRAND TOTAL:_________
Saturday, October 9 W3. Ticketed 18” Warm-up @ $20.00 6:00am – 6:30am W4. Ticketed 2’3” Warm-up @ $20.00 6:30am – 7:30am 12. Pony Hunter Pleasure Championship @ $35.00 13. Hunter Pleasure Championship @ $35.00 14. 2’3” Open Hunter @ $40.00 15. 2’3” Hunter Classic @ $50.00 16. Open Pony Hunter Classic @ $50.00 17. 2’6” Open Hunter @ $40.00 18. 2’6” Hunter Classic @ $50.00 19. 2’9” Hunter Classic @ $50.00 20. 3’ Open Hunter Classic @ $50.00 21. 18” Open Hunter @ $40.00 22. 18” Hunter Classic @ $50.00 23. NH Team Challenge @ $35.00
_______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______
th
Sunday, October 10 W5. Ticketed 2’3” Warm-up @ $20.00 6:00am – 7:00am W6. Ticketed 18” Warm-up @ $20.00 7:00am – 7:30am 24. 18” Novice Equitation @ $40.00 25. NH 18” Novice Medal @ $75.00 26. 2’3” Equitation @ $40.00 27. NH Children’s Medal @ $75.00 28. NH Modified Adult Medal @ $75.00 29. NH Pony Medal @ $75.00 30. Adult Equitation @ $40.00 31. NH Adult Medal @ $75.00 32. Equitation Under 15 @ $40.00 33. Equitation 15 – 17 @ $40.00 34. NH Junior Medal @ $75.00
_______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______
Total Class Fees: ________ Entries must also be accompanied by signed open check
PLEASE READ CAREFULLY: Under New Hampshire law, a participant in equine activities assumes the risk of any injury, harm, damage, or death and any legal responsibility that may occur to a participant from the inherent risks associated with equine activities. Pursuant to R.S.A 508:19, Equine Professionals are not liable for damages resulting from the inherent risks of equine activities. All owners and exhibitors will be held responsible for any damages incurred by them , their agents or employees to buildings, stalls, rings and other properties on show grounds, and will be billed accordingly. I agree to hold harmless New Hampshire Hunter Jumper Association and NEHC, its employees, officers, and show grounds from any damage or injury that occurs to any horse or rider, including myself that I bring to the 2010 New Hampshire Equitation & Hunter Finals on October 8, 2010 to October 10, 2010.
X______________________________________________ Rider’s Signature (parent/guardian if under 18; if not available, trainer must sign)
X______________________________________________ Owner’s/Agent Signature
Name of Rider:_____________________________________ Address:__________________________________________ City:___________________ State:________ Zip:____________ Phone Number:_____________________
Name of Owner/Agent:_____________________________ Address:__________________________________________ City:___________________ State:________ Zip:____________ Phone Number:_____________________
X______________________________________________ Trainer’s Signature Name of Trainer:_____________________________________ Address:__________________________________________ City:___________________ State:________ Zip:____________ Phone Number:_____________________
NO ENTRY WILL BE ACCEPTED UNLESS ALL SIGNATURES ARE PRESENT ON BOTH SIDES OF ENTRY FORM