Blue Goose Stable, LLC                                                                        Blue Goose Stable, LLC Combined Test Entry

210 White Horse Rd                                                                                                2008

Cochranville PA 19330                               

Print in Landscape Form

Text Box: FEES ENCLOSED Entry: $50.00/div                  $_________ Pinney: (CT entry only)       $20.00 Late Entry: ($25.00)              $_________  TOTAL                               $_________               

 

ONE horse per form – please print

All information is required – fill in all blanks – use N/A if necessary

Mail entry form with current coggins and applicable fees to event secretary

 

 

 Event:________________________________ Event Date:_____________

 

Rider Name:______________________ Division:_______

 

Horse Name:________________________________ Color:_____ Breed:______Sex:______Height:_____

 

Rider Information: Please PRINT Clearly       Jr y   Yry  Sr y     Date of Birth ___________

 

Street:_________________________________________________________________________

 

Town:_______________________________________ State:_____________ Zip:____________

 

Tele No.___________________________ Email:______________________________________

 

Owner:_______________________________________________________________________

 

Street:_________________________________________________________________________

 

Town:_______________________________________ State:_____________Zip:____________

 

Tele No.______________________________Email:____________________________________

 

Horse & Rider Experience

Rider has no experience at this level____________________-Highest level ridden____________

Horse has no experience at this level____________________ Highest level competed_________

Text Box: RELEASE OF LIABILITY AND AGREEMENT OF ENTRY: Every entry at this competition shall constitute an agreement and affirmation that all participants (which include, without limitation, the owner, lessee, trainer, manager, agent coach, rider, handler, and the horse), for themselves, their principals, representatives, employees and agents: (1) shall be subject to the local rules of the competition; (2) represent that every horse and rider is eligible as entered; (3) agree to be bound by the rules of the competition, and will accept as final the decision of the Ground Jury on any question arising under said rules, and agree to hold the competition harmless for any action taken; and (4) agree that they participate voluntarily in the competition fully aware that horse sports and the competition involve inherent dangerous risk of serious injury or death, and by participating they expressly assume any and all risks of injury, loss, and they agree to indemnify and hold harmless the competition, and their officials, employees and agents harmless from and against all claims including for any injury or loss suffered during or in connection with the  competition, whether or not such injury or loss resulted , directly or indirectly, from the negligent acts or omissions of said owner, officials, managers, employees or agents of this competition. RELEASE: I understand that this is a high-risk sport and am participating at my own risk.  I hereby assume this risk and further do hereby release and hold harmless the Organizer, the Organizing Committee, judges and officials, the host of this event or horse trial and the owners of any property on which this event, horse trial is to be held, from all liability from negligence resulting in accidents, damage, injury or illness to myself and to my property, including the horse or horses which I will compete at this event or trial.  Signed; Rider:______________________________________________________                 Owner:_____________________________________________________                 Parent/Guardian:_____________________________________________                 (If rider /owner is 18 or under)