ENTRY FORM128 & Under138cm & Under148cm & Under

Race to be entered: 1 2 3 45 6 7

(circle as appropriate)

RIDER DETAILSPRINT or TYPE DETAILS CLEARLY AND IN BLACK INK

Name: ...... ……………………………………………………………......

Age on 1st January 2018 ...... Date of birth………………………

Pony Club Branch/Centre: ……………………………………………………………...... Area: ......

PONY DETAILS Name: …………………………………………………………………………………

Age……………Colour…………………...... Height …………......

NOVICE RACES: Has the Rider won a Champion Safety Wear Hat Voucher before YES / NO

CONTACT DETAILS

Name: ......

Address: ……………………………………………………………………………………………………....

……………………………………………………………………………………………………………….....Post Code …………………………… e mail. ………………………………………………………….....

Telephone / Mobile Number: ………………………………………………......

I confirm that I/we have read a copy of The Pony Club Pony Racing Rules 2018 and that I/we agree to abide by them.

Photographic rights - competitors and their guardians hereby give permission for any photographic and/or film or TV footage taken of persons or horses/ponies taking part in the Pony Club events to be used and published in any media whatsoever for editorial purposes, press information or advertising by or on behalf of The Pony Club and/or official sponsors of The Pony Club.

Signed: ………………………………………………………………………………. Parent/Guardian

Parent/Guardian - please also read and sign the declaration over the page.

QUALIFICATION:

I confirm that ………………………………………………… ………………...... is a Member of the

………………………………………………….………………………...... Branch/Centre of The Pony Club and the Combination of Member and Pony (named above) have participated in

i)a minimum of 2 (ridden) working rallies or

ii)a minimum of 1 passed PRA/PC Training Day

(give date and venue of Training Day) ......

since the 1st July the previous year.

Signed …………………………………………………....District Commissioner/ Centre Proprietor

Print Name: ………………………………………………………………………………………………..

Do not forget a Photocopy of Vaccination Certificate and CHECK IT IS CORRECT and a copy of JMB Certificate (if applicable)

2018 Entry/Declaration Form

PARENT/GUARDIAN DECLARATION

I confirm that I want my son/daughter (Full name) ………………………………………………

To enter and be permitted to ride his/her pony in the above event; I confirm on my own behalf and on behalf of my son/daughter that I recognise that riding including riding at speed in company of other children and ponies is an activity with considerable attendant risks. I acknowledge that whilst the organisers of the above event, their officials and employees, will endeavour to reduce risks to those participating they cannot be held responsible for the errors of participants or unexpected animal behaviour.

I accept that it is a condition of entry that the rider will do his/her best to conduct him/herself and to ride his/her pony in such a way as to minimise risk of injury to him/herself and to other riders, their ponies and spectators. I have impressed the need for good and sensible behaviour on my son/daughter and have checked his/her pony, tack and other equipment to ensure that all is in order and that nothing about the pony’s tack or other equipment presents a danger to my son/daughter or to other riders or ponies participating in the race or to the organisers, officials, employees or others watching the race.

I understand riding is a risk sport. I am aware there is risk of injury. In the knowledge of this I confirm that I believe my son/daughter to be a competent Rider who is capable of riding in The Pony Club Race Day and subsequently I am happy for him / her to participate. He / she is in good mental and physical health and I know of no condition that would currently preclude them from riding in Pony Races. I accept and agree to abide by The Pony Club Racing Regulations and confirm that the information provided is correct.

Signed. ……………………………………………………….. ……………… Parent/Legal Guardian

Print Name. ……………………………………………………………………………………………......

Date. …………………………………………………………..

2018 Entry/Declaration Form

Lord Leconfield Pony Club Race Day

Branch/Centre ______

Commentators Notes

Rider Name: / Rider Silks:

Please colour.
Pony name:
Jockey Name:
Non-horsey Interests (e.g. play another sport, sing in a band!)
Any quirky stories about you or your pony! :
Past record of achievement in Pony Club Pony Racing:

2018 Entry/Declaration Form

CHECKLIST to be completed and sent with Entry Form

The below must be included for entries to be accepted / Completed
✔
District Commissioner/Centre ProprietorSignature
Parent/Guardian Signature
Racing colours
Pony’s full vaccination history (not just previous years vaccination)
Copy of JMB Certificate (if applicable)
Entry fee (£20 per rider per race)
First Aid (£5 per rider)
TOTAL / £

Please ensure that all tack fits and complies with Pony Club Racing rules.

Please post entries to:

Mrs Ruth Simmonds

Nyetimber Farm

Gay Street

Pulborough

West Sussex

RH20 2HH

Only hard copies in advance will be accepted as required

by Ascot Racecourse.

Email confirmation will be sent once entries received.

Please contact if you do not hear that your entry has been received within a week of posting it. Thank you.

Closing date: 22nd March 2018.

2018 Entry/Declaration Form