Rider Name ______________________________________________________
Address__________________________________________________________
________________________________________________________________
Horse Name ______________________________________________________
Horse Number _______________________ Height _________ EIA # _________
Leadline walk/halt Leadline walk/trot Leadline walk off lead Walk/trot Division Equitation Walk/trot Division Equitation Advanced Walk/trot Division Pleasure Beginner Equitation walk/halt Beginner Equitation walk/trot Beginner Equitation walk/trot/canter Beginner Equitation 4 cross rails Hopeful Hunter walk/trot Hopeful Hunter walk/trot/canter Hopeful Hunter 6 fences - 21" Junior Equitation walk/trot Junior Equitation walk/trot/canter Junior Equitation 6 fences - 21" Senior Equitation walk/trot Senior Equitation walk/trot/canter Senior Equitation 6 fences - 21" ****** Schooling Break ****** Low Pleasure walk/trot Low Pleasure walk/trot/canter Low Pleasure walk/trot/canter & 2 fences Low Pleasure 6 fences - 2' Pony Hunter over fences Pony Hunter over fences Pony Hunter under saddle Modified Hunter over fences
Number of Classes_____ x $10 = Amount Due____________
Total Paid __________ Check # _____________ Cash ____________
RELEASE: I understand that this is a high risk sport that can result in serious injuries or death, and I am participating at my own risk. I hereby assume this risk and further do hereby release and hold harmless this show, Outlaw Stable/Tara Dawn Hazen, its sponsors, employees, the organizers, show committee, volunteers, officials, family members, etc., from all liability due to negligence, accident, loss, damage, injury, illness or death to myself and my property, including the horse (s) which I will compete at this event.
