Page 1

Entry #

Great Southwest Fall Classic Show

A

B

HUNTER Reg 1st CLASSES Hntr Grn

Mail Entries to:

(Entries close September 20, 2010)

C 2nd Grn

GSEC 2501 S. Mason Road September 30 – October 3, 2010 Great Southwest Equestrian Center, Katy, TX Katy, TX 77450 - (281) 579-1272 D E F G H I J K L M N O P Q R S T U V W X Y Z YY A/O A/O A/O LgJr SmJr Lg Med Sm L Gr S/M Gr Child Child AdAm AdAm AdAm LwPre HiPre Mod Child Low Limit Baby Hope Shrt/Long 3’3” 18-35 36/O Hntr Hntr Pony Pony Pony Pony Pony 14/U 15-17 18-35 36-49 50/O Grn Grn Ch/Ad Pony Hntr Hntr Grn Hntr Strp

CC

DD

Rider #1 Rider #2 AA

BB

EE

FF

GG

HH

II

JJ

KK

_______Stalls@ $175. ______ 30 amp RV @ $225. ______50 amp RV @ $225.

LL

JUMPER TJ TJ TJ TJ TJ Low High High Open Open Low High CLASSES 0.75 0.95 1.00 1.15 1.25 Ch/Ad Child AdAm 1.30m 1.40m Jr/Am Jr/AO

List Equitation & Individual Classes Below

Rider #1 Rider #2

Green 1 2 USEF# THJA#

OWNER

Name: Address: City: State, Zip: Phone# Color Sex Hgt Age USEF#

RIDER #1 Name: Address: USEF# THJA# Age/Age Group

THJA#

Prize Money/Tax Payer Info – MUST COMPLETE Tax payer name: SS# or Fed ID# Prize Money Payee Address:

ASPCA# USHJA# RIDER #2

Name: Address: USEF# THJA# Age/Age Group

Federation Entry Agreement I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR906.4) as printed in the Prize List for [Southwest Showdown] (“Competition”) and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, the Prize List, and local rules of the competition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against the Federation must be brought in New York State. EC 9/21/09 Effective 12/1/09 Federation Release, Assumption of Risk, Waiver, and Indemnification This document waives important legal rights. Read it carefully before signing. I AGREE in consideration for my participation in this Competition [Southwest Showdown] to the following: I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”). I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results resulted, directly or indirectly, from the negligence of the Federation or the Competition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition. BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank. Rider/Driver/Handler/Vaulter/LongeurOwner/Agent - mandatory) Trainer - (mandatory) (mandatory)

$15.00

$50.00

USHJA Zone Support Fee $2. Total Due.

ASPCA# USHJA#

Amount Enclosed . Rec’d Check #. Make Checks to: GSEC STABLE WITH TRAINER INFO

HORSE

Jumper Nomination fee @$150. Late Jumper nomination fee @175. Non-showing Horse Fee $100. USEF Non Member Amateur Card $30. USEF fee $8 Drug testing $7. USEF N/M Fee (Jr:$30, Sr:$30). THJA N/M Fee $10. USHJA N/M Fee $30. Office & Administration Fee $50. Late Fee $35 Ground Fee $50.

NAME ADDRESS City, State, Zip Ph# USEF #

I agree neither Great Southwest Equestrian Center LP, nor the Show Committee, nor Patrick Rodes & Southbound Show Management, nor the officials and/or staff of the show will be responsible for any accident, damage, loss or injury to count, owner, rider or other persons or property. It will be the condition of entry that each exhibitor shall hold the horse show and its management blameless for any loss or accident to any animal, person or property that may occur from sickness, fire and otherwise at this show. Under Texas law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities.

Coach - (if applicable) Signature Signature Signature Signature Print Name Print Name Print Name Print Name Parent/Guardian Signature (required if Rider/Driver/Handler/Vaulter/Longeur is a minor)_______________________________ Print Parent/Guardian Name____________________________ Is Rider/Driver/Vaulter a US Citizen? ___ Yes ____

EMAIL ADDRESS_______________________ Emergency Contact / Cell Phone No._____________


http://www.gswec.com/downloads/2010PrizeLists/Great%20Southwest%20Fall%20Classic%202010%20Entry  

http://www.gswec.com/downloads/2010PrizeLists/Great%20Southwest%20Fall%20Classic%202010%20Entry.pdf

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