CT Entry Form

Wakefield Valley Pony Club
Combined Test
Sunday, May 2, 2010
Lehigh Riding Club
http://www.stableandarena.com/lehigh/
121 W. Deep Run Road Westminster, MD 21157

Opening Date: March 15, 2010 Closing Date: April 21, 2010

Rider:______________________________________________________________

Address:____________________________________________________________

City:______________________________ State:________ Zip:______________

Phone #:___________________________ Email:__________________________

EmergencyContact:_____________________EmergencyContact Phone#____________

Division	Dressage Test - Small Arena	Jump Height
Elementary	USDF 2007 Intro A	12"-18"
Baby Beg. Novice	USEF 2010 Beg. Novice A	Max ht 2'
Beg. Novice	USEF 2010 Beg. Novice B	Max ht 2'6"
Novice	USEF 2010 Novice A	Max ht 2'11"
Training	USEF 2010 Training A	Max ht 3'3"

	CT - $40 Dressage Only - $30 Extra Jump Rounds - $5

Please check desired division:

___CT Elementary Div	$40	___Dressage Only Elementary Div	$30
___CT Baby Beginner Novice	$40	___Dressage Only Baby Beginner Novice	$30
___CT Beginner Novice Div	$40	___Dressage Only Beginner Novice Div	$30
___CT Beginner Novice Div	$40	___Dressage Only Beginner Novice Div	$30
___CT Novice Div	$40	___Dressage Only Novice Div	$30
___CT Training Div	$40	___Dressage Only Training Div	$30
___Extra Jump Rounds	$5*	Patron Ad Fees:
		Total Entry Fees:

*with entry in any CT division

All entries to include an entry form for each horse and rider combination, current coggins for each horse, and a check for the total fees made out to W.V.P.C. Ride times will be posted onthe WVPC website the Wednesday prior to the event at http://www.wakefieldvalley.ponyclub.org/

Mail entries to:
Vicky Baugher, Show Secretary
745 Holland Lane
Westminster, MD 21158
Email: utownbaughers@comcast.net

Concessions Available

Recognize your favorite rider with a $5 Patron Ad

All riders must sign the following release:

We recognize that there are inherent risks and dangers relating to horses and horse shows. In consideration of the Wakefield Valley Pony Club, the Capital Region Pony Club and the U.S.P.C. accepting our application to participate in this show, we hereby agree to asume all risks associated therewith and do hereby release and agree to indemnify and hold harmless Wakefield Valley Pony Club, Capital Region Pony Club and U.S.P.C. its agents, servents, and employees, for all causes of action, including negligence, which may accrue as a result of any damage or injury to me, us or our property.

Rider/Entrant____________________________________________________________ Horse Owner if different than the Entrant____________________________________

If the participant is under age 18, we as the child's parent/guardian, hereby consent, jointly and severally, to the child's participation and if the participant is under age 18, we as the child's parent/guardian, hereby consent jointly and severally, to the child's participation and said child or to the child's property.

Parent__________________________________________________________ Parent_______________________________________________________________________

We hereby give our permission for photographs taken of this horse/rider entry to be used for promotional/publicity purposes.

Patron Ads

Recognize your favorite rider with a $5 patron ad.

Name of Rider:______________________________________________

Patron

Ad:______________________________________________________________________________________________________________________________________________________________________________________________________________________

Name of Rider:______________________________________________

Patron

Name of Rider:______________________________________________

Patron