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Calvert Chapter Potomac Valley Dressage Association 2010 FIX-A-TEST ENTRY FORM • Riders may enter the Fix-A-Test clinic by using this form. • Rider need not be a PVDA members unless otherwise specified. • Telephone entries will not be accepted. • The entire entry form must be completed and current coggins must be submitted. • Indicate which test(s) you want to ride • Include a valid, legible email address for ride times. Ride time will also be posted on the website by the Monday before the clinic. NOTE: A separate entry form must be submitted for each horse/rider combination. HORSE NAME

RIDER NAME

TEST

FEE

Rider Name: Rider E-mail: Rider Address: TOTAL FEES: Rider Phone:

Emergency Contact:

I/We recognize that there are inherent risks and dangers relating to horses and horse events. In consideration of the Calvert Chapter accepting our application to participate in this show, we hereby agree to assume all risk associated therewith and do hereby release and agree to indemnify and hold harmless the Calvert Chapter, its agents, servants, 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. Signature(s): Entrant/Rider

Horse Owner (if different)

Did you enclose a stamped self-addressed envelope and want to have your ride times mailed to you: Do we have person to use photographs of you and/or your horse for promotional/publicity purposes: [DO NOT DETACH] Event Location:

Date: HORSE

RIDER

TEST

TIME

NOTE TO ENTRANT: PLEASE COMPLETE THE INFORMATION ON THIS PART OF THE FORM. THE EVENT MANAGER WILL INSERT YOUR RIDE TIMES AND RETURN IT TO YOU IF YOU HAVE PROVIDED A SELF-ADDRESSED, STAMPED ENVELOPE.


Calvert Fix-a-Test  

Entry from for Calvert Fix-a-Test clinc.

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