Blue Goose Stable, LLC

Dressage Entry Form 1/1/2008      Please make copies  One horse per form

Mail Entries to:  Blue Goose Stable, LLC   210 White Horse Rd  Cochranville PA 19330

Competition Date: __________________________________   

 

Horse:	Breed:	Gender:	Color:	Age:
Rhino / Flu Vaccination Date:   ----/----/----  //  Coggins (EIA) Report: State __ Accession #____________________   Copy enclosed:   Yes / No  //       Are you a member of DVCTA _____       FCDA______
Rider:	Address:
JR DOB:
Phone:	E-mail:
Owner:	Address:
Phone:	E-mail:
Class #	Class Description:  Test / Level / Division

 

 

Class #	Class Description (Level/Test)  Q - Qualifier	Total Test fees @ $25.00 /  test		$
		Subtotal Class fees	XXXXXXX	$
		Late Fee ( entries made after closing date)	$25.00
		Total Fees	XXXXXXX	$

 

Warning: Under Pennsylvania law an equine professional and equine activity sponsor is not liable for an injury to or death if a participant in equine activities resulting from the inherent risks of equine activities. 

I/We acknowledge that equine activities are a high risk activity.  In consideration of the acceptance of this entry, whether I am mounted or unmounted, I release and in addition hold harmless Blue Goose Stable, LLC , it's owners and agents, of and from any and all claims and demands of every kind which I may have or hereafter acquire for bodily injury, death, or property damage and from all liability for negligent acts or omissions.

 

Signed Rider:__________________________Date:__________   (Parent or Guardian, if rider is under 18)

 

Signed Owner:_________________________Date:___________