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Mo Hot Daze Horse Show & Britannia Farm Horse Show

ENTRY FORM Checks payable to: Britannia Farm 26901 West Brooks Rd. Waller, TX 77484

NUMBER (office use only)

September 8 & 9, 2012

ENTRY FEES

Entries received after 6 pm Thursday will pay $10 late fee. Mail or fax to 281-578-6651 before 6:00 p.m. Friday. Entries received by 5:00 pm Wednesday receive $10 credit on account

NAME OF HORSE

OWNER

COGGINS Acc. #: _________________ Date: _________ Lab:______________

______STALLS @ $70.00 ______STALLS @ $50.00

RIDER

______DAY STALL @ $40/day

___________________________________

____________________________ ______ NON—SHOWING FEE @ $30/day

Name

Name

___________________________________

___________________________________

Address

Address

___________________________________

___________________________________ OFFICE FEE @ $10 per entry

City, State, Zip

City, State, Zip

Horse GHHJA #: ___________________ OWNER GHHJA #: _________________

Age

B

C

D

E

F

G

______SHAVINGS

GHHJA N/M FEE @ $10

RIDER GHHJA #: ___________________

CLASS FEES LATE FEE

MARK DIVISIONS ENTERED FOR EACH DAY A

____GROUND FEE @ $20/day

H

I

J

K

L

M

N

O

Pre Non Walk Pre Grn Sm Med Lg Limit Jr/Ad Low Opn Sch Beg Nov Grn Pro Trot Beg Grass Pony Pony Pony Hntr Hntr Hntr Hntr Hntr Hntr Hntr

P

Q

R

TOTAL

S

Sch Jr/Ad Open Ity Bity Jmpr Jmpr Jmpr Jmpr

SAT

INDIVIDUAL CLASSES

EQUITATION CLASSES

SAT SUN

SUN THIS ENTRY IS AN AGREEMENT THAT THE PERSON ENTERED, ALONG WITH THE OWNER, LESSEES, TRANER, MANAGER, COACH AND HORSE: (1) THAT EVERY HORSE AND RIDER IS ELIGIBLE AS ENTERED; (2) THAT THE OWNER AND ANY OF HIS/HER REPRESENTATIVES WILL AGREE TO THE FINAL DECISIONS MADE BY THE MANAGEMENT AND HOLD THE COMPETITION OF THE GHHJA, PAULINE COOK; DBA BRITANNIA FARM, GREAT SOUTHWEST EQUESTRIAN CENTER L.P., MAURENE MOFFETT, THEIR OFFICIALS, THE MANAGEMENT EMPLOYEES AND AGENTS HARMLESS FOR ANY INJURY OR LOSS SUFFERED DURING OR IN CONJUNCTION WITH THE COMPETITION, WHETHER OR NOT SUCH INJURY OR LOSS RESULTED, DIRECTLY OR INDIRECTLY, FROM THE NEGLIGENT ACTS OR OMISSIONS OF SAID OFFICIALS, EMPLOYEES, AGENTS, THE MANAGEMENT, GHHJA, PAULINE COOK; DBA BRITANNIA FARM, GREAT SOUTHWEST EQUESTRIAN CENTER L.P. MAURENE MOFFETT, . WARNING, UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATHOF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.

PERMISSION FOR A MINOR TO SHOW: MUST be signed if rider is under 18 years of age. Numbers will not be issued until this form is signed! I hereby consent to the entry of my child _____________________________________ in this show and certify that I have read the foregoing representations and statement, and that I hereby agree and accept responsibility there under for the participation of said minor. _____________________________________________________________ Signature of Parent/Guardian/Trainer

PLEASE STABLE WITH: Notice: Stalls will not be held unless check accompanies entry. Trainer’s Name ____________________________________________________ Trainer’s Signature __________________________________________________ Trainer’s GHHJA Number ____________________________________________ Where a minor exhibitor has no trainer, parent or guardian must sign and assume responsibility.

Exhibitor Signature _________________________________________________ (Must be signed by exhibitor, owner or his agent.)

Email Address: (required) ____________________________________ (Must be filled in by exhibitor or owner)

Emergency Contact / Cell Phone No.___________________________


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