CT Entry Form

Wakefield Valley Pony Club
Combined Test, Dressage & Jumper Show
CANCELLED October 4, 2009 CANCELLED
New Location - Lehigh Riding Club
http://www.stableandarena.com/lehigh/
121 W. Deep Run Road Westminster, MD 21157

Opening Date: August 17, 2009 Closing Date: September 19, 2009

Rider:________________________________________________________ Email:________________________________________________

Address:__________________________________________ City:______________________________ State:________ Zip:______________

Emergency Contact:________________________________________ Emergency Contact Phone:_____________________________

Division	Dressage Test - Small Arena	Jump Height
Elementary	USDF 2007 Intro A	12"-18"
Baby Beg. Novice	USEF 2006 Beg. Novice A	Max ht 2'
Beg. Novice	USEF 2006 Beg. Novice B	Max ht 2'6"
Novice	USEF 2006 Novice A	Max ht 2'11"
Training	USEF 2006 Training A	Max ht 3'3"

Costs	CT - $40 Dressage Only - $30 Jumping Only - $30 Extra Jump Rounds - $5 to be paid at gate

Division	Indicate CT, Dressage Only, Jumpers Only	Horse	Cost





		Patron Ad Fees:
		Total Entry Fees:

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:
Gina Resch, Show Secretary
1670 Hosfeld Drive
Westminster, MD 21157
Email: bean@qis.net

Concessions Available

Recognize your favorite rider with a $5 Patron Ad

Relaxed Show Format - Great opportunity for inexperienced riders or horses

Schooling attire OK (collared shirt and britches)
No bit check
Approved head gear must be wore any time a rider is mounted on a horse; medical armbands are required for jumping phase. Pony Clubbers may use the 2009 USPC medical release in the armband. Riders without an armband will not be permitted to jump.
Dogs must be on a leash at all times.
No refunds after closing date.

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