Lower Puget Sound Dressage Club
Chapter of the Equestrian Institute
2008
Schooling Show Entry Form
Show Dates: May 18, June 15, July 13 September 21
(Please circle the schooling show you are entering. One entry form per show, please)
Please Note!!! The "OPENING & CLOSING" DATES FOR EACH SHOW in your omnibus.
We will be excepting entries in the order received, until the show is full! All others will be put on a wait list.
(Only one HORSE/RIDER combination per entry form. Please use separate entry form for additional HORSE/RIDER combinations.)
Rider Information
Name:__________________________________________
Address:_______________________________________
_________
________________________________________________
Home Phone:( )_________________________
Cell: ( )_______________________________
E.I. #_________ WSH # ___________
OPEN___Amatuer____Jr/YR____
Jr/YR Birthdate:_________ Age:____
Email Address:___________________________________
LPSDC: 2008 Member Yes or No
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Horse & Owner Information
Horses Name:________________________
Owners Name:______________________________________
Address:__________________________________________:
_________________________________________________
Home Phone:( )___________________________________
Cell: ( )__________________________________________
E.I. #_________ WSH # ________
OPEN___Amatuer____Jr/YR____
Jr/YR Birthdate:_________ Age:____
Email Address:___________________________________
LPSDC: 2008 Member Yes or No
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NOVICE RIDER
Let us know if you have
shown dressage for less
than two years in either...
Intro Level Classes:___
Training Level Classes _____
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PLEASE List RIDES IN
ORDER OF PREFERENCE
(Riders may be limited to two
(2) per horse/rider
combinations. If entries warrant.)
USEF Rule DR119 No more
than 3 classes per horse.
Class Number
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Level
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Test Number
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Every entry at a LPSDC show shall constitute an agreement and affirmation that the person making it; owner, lessee, trainer, manager, agent, coach, driver, or rider; and the horse;
(1) shall be subject to the local rules of the show; (2) that every horse, rider and/or driver is eligible as entered; (3) that the owner and any of his/her representatives are bound by the
constitution and rules of the show and agree to accept as final the decision of the Hearing Committee on any questions arising under said rules and agree to hold the show, LPSDC,
Equestrians Institute, WSH, their officials and employees harmless for any action taken; (4) the owner, rider/driver and any of their agents or representatives acknowledge that they
participate voluntarily in the show fully aware that horse sports and the show involve inherent, dangerous risk, and by participating they expressly assume any and all risks of injury or
loss, and they agree to hold the LPSDC, Equestrians Institute, Green Hills Farm or Sawda Equestrian Center, WSH, the show and their officials, directors, employees and agents
harmless 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 officials, directors, employees o r agents of the show. The construction or application of said rules is governed by the laws of the State of Washington.
X_____________________________________ X_______________________________________
Signature of Rider Signature of Owner or Authorized Agent
Permission for Minor to Show
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 the same may be deemed a part thereof, and
hereby accept responsibility thereunder for the participation of said minor.
X_____________________________________ Parent or Guardian Name:_________________________
Signature of Parent or Guardian Home Phone Number: ( )_______________ Cell: ( ) ______________
Office Use Only
NUMBER _________________
Member:__________ Check No.:____________
Owner Sign:_______ Amt:$_______________
Rider Sign:________
Minor:____________
Refund Due:$___________
For:_______________________
Note:____________________________________________________
____________________________________________________
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LPSDC Schooling Show Entry Fees
(NO entry will be accepted unless fees are enclosed.)
No. of Tests
____LPSDC Members ONLY @ $15.00 per test $_________
____Non-LPSDC Members @ $25.00 per test. $_________
Show Grounds Fee. $_____ 5.00
Late Fee $10.00 per show. $_________
Subtotal: $_________
Less Dressage $$ enclosed. ($_________)
Total Fees Enclosed: $_____________
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Mail Entries to: Robin Cummins, 13185 Wicks End LN., Port Orchard, WA 98367/Email: dressagerobin@yahoo.com (No entries excepted by email