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Printing compliments of Grinnell Mutual Reinsurance Company

JULY 12-14 ENTRY FORM

BACK NUMBER

one sheet per horse

number stays with the horse circle one

Horse Name

Mare Gelding Stallion

Exhibitor #1 Name

Birthday

Exhibitor #1 Address

City

e-mail

Zip Code

ph# while at show (

Exhibitor #2 Name

Birthday

Exhibitor #2 Address

City

e-mail

Age or Year foaled

)

Zip Code

ph# while at show (

)

Responsible Party for the Bill Check appropriate boxes on reverse side to enter classes Release of Liability I, the undersigned, wish to participate in the Grinnell Saddle Club events listed on below. I understand that a number of inherent risks are associated with a domesticated animal activity. A domesticated animal may behave in a manner that results in damages to property or an injury or death to a person. Risks associated with the activity may include injuries caused by bucking, biting, stumbling, rearing, trampling, scratching, pecking, falling, or butting. The domesticated animal may act unpredictably to conditions, including, but not limited to, a sudden movement, loud noise, an unfamiliar environment, or the introduction of unfamiliar persons, animals, or objects. The domesticated animal may also react in a dangerous manner when a condition or treatment is considered hazardous to the welfare of the animal; a collision occurs with an object or animal; or a participate fails to exercise reasonable precautions, or use adequate control when engaging in a domesticated animal activity, including failing to maintain reasonable control of the animal or failing to act in a manner consistent with the person’s abilities. In consideration of the Grinnell Saddle Club allowing my participating in any of the events listed below, I, on behalf of myself, and my heirs, administrators, personal representatives, assigns and children and spouse, if any, do hereby agree to hold harmless, release and discharge the Grinnell Saddle Club and/or the Poweshiek County Fair Association and/or the Iowa Equestrian Center which includes officers, directors, members, agents, representatives, affiliates and insurers, or and from all claims, demands, causes of action and legal liability whether known or unknown, anticipated or unanticipated, due to the ordinary negligence of the Grinnell Saddle Club and/or the Poweshiek County Fair Association and/or the Iowa Equestrian Center I shall not bring any claims, demands, legal actions or causes of action against the Grinnell Saddle Club and/or the Poweshiek County Fair Association and/or the Iowa Equestrian Center for any damage or loss due to bodily injury, death or property damage arising out of my participation in any of the events listed below. WARNING Iowa’s Equine Warning Law UNDER IOWA LAW, A DOMENTICATED ANIMAL PROFESSIONAL IS NOT LIABLE FOR DAMAGES SUFFERED BY, AN INJURY TO, OR THE DEATH OF A PARTICIPANT RESULTING FROM THE INHERENT RISKS OF DOMESTICATED ANIMAL ACTIVITIES, PURSUANT TO IOWA CODE CHAPTER 673. YOU ARE ASSUMING INHERENT RISKS OF PARTICIPATING IN THIS DOMESTICATED ANIMAL ACTIVITY. _________________________________________________________ Signature of Participant

__________________ Date

_________________________________________________________ Signature of Parent or Guardian

__________________ Date

(If participant is a minor.) Grinnell Saddle Club 2013 Event Schedule:

Saturday, June 1 @ 9:00 a.m. Saturday, June 29 @ 9:00 a.m. Saturday, August 3 @ 9:00 a.m. Saturday, September 14 @ 9:00 a.m

Friday-Sunday, July 12-14 @ 8 a.m.


Check appropriate boxes to enter classes for each day

Sat. Sun. # 1 2 3 4 5 6 7 8 9 10 16 15 14 13 12 11 17 18 20 21 22 23 24 19 25 27 26 28 32 33 34 35 31 36 49 30 29 43 44 45 46 38 47 48 50 51 52 53 37 42 41 40 39

EXHIBITOR #1 Class HALTER Weanling Yearling Ponies 2 & 3 Yr. Old 4 & Older-Mares 4 & Older-Geldings 13 & Older Horses Color Breed Quarter Horse Non-Sotck Yearling LL SHOWMANSHIP 12 & under 13-15 yrs. 16-18 yrs. 19 & over 40 & over ENGLISH W/T 18 & under W/T 19 & over HUS 18 & under HUS 19 & over Equitation 18 & under Equitation 19 & over Hunter Hack Jackpot HUS Lead Line Teddy Bear Race WALK-TROT W/T 8 & under W/T 9-12 yrs. W/T 13-15 yrs. W/T 16-18 yrs. W/T 19 & over W/T 40 & over Pony W/T Ranch Horse Style W/T 2 & 3 yr. old W/T Jackpot W/T PLEASURE WP 12 & under WP 13-15 yrs. WP 16-18 yrs. WP 19 & over WP 40 & over Pony WP Ranch Horse Style WP Non-Stock Pleasure Jr. WP (5 & under) Sr. WP (6 & over) Ladies WP Men's WP Jackpot WP HORSEMANSHIP Hrsmnshp 12 & Under Hrsmnshp 13-15 Hrsmnshp 16-18 Hrsmnshp 19 & Over

54 Reining (all ages)

Sat. Sun. # 1 2 3 4 5 6 7 8 9 10 16 15 14 13 12 11 17 18 20 21 22 23 24 19 25 27 26 28 32 33 34 35 31 36 49 30 29 43 44 45 46 38 47 48 50 51 52 53 37 42 41 40 39

EXHIBITOR #1 Class HALTER Weanling Yearling Ponies 2 & 3 Yr. Old 4 & Older-Mares 4 & Older-Geldings 13 & Older Horses Color Breed Quarter Horse Non-Sotck Yearling LL SHOWMANSHIP 12 & under 13-15 yrs. 16-18 yrs. 19 & over 40 & over ENGLISH W/T 18 & under W/T 19 & over HUS 18 & under HUS 19 & over Equitation 18 & under Equitation 19 & over Hunter Hack Jackpot HUS Lead Line Teddy Bear Race WALK-TROT W/T 8 & under W/T 9-12 yrs. W/T 13-15 yrs. W/T 16-18 yrs. W/T 19 & over W/T 40 & over Pony W/T Ranch Horse Style W/T 2 & 3 yr. old W/T Jackpot W/T PLEASURE WP 12 & under WP 13-15 yrs. WP 16-18 yrs. WP 19 & over WP 40 & over Pony WP Ranch Horse Style WP Non-Stock Pleasure Jr. WP (5 & under) Sr. WP (6 & over) Ladies WP Men's WP Jackpot WP HORSEMANSHIP Hrsmnshp 12 & Under Hrsmnshp 13-15 Hrsmnshp 16-18 Hrsmnshp 19 & Over

54 Reining (all ages)

Entries @ $3 = Entries @ $6 = Entries @ $10 = Camping @ $20 = Stalls

@

=

Amount Due = Total Payback = BALANCE DUE GSC or Exhibitor

checked out by initials


Kirkwood Entry Form July 12-14  
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