ENTRY FORM FOR CHARITY FUN SHOW

/ Honey’s Tack N’ Feed
1199 MacDonald Road, Russell, Ontario K4R 1C9
Tel. - 613 445-5550
FAX- 613 445-1177
email
website www.honeystack.com / NUMBER

August 30, 2009

ENTRIES CLOSE August 22nd AT 4:00 pm. One Form Per Horse/Rider

HORSE NAME:
OWNER:
ADDRESS:
POSTAL CODE: PHONE
EMAIL: FAX:
RIDER: Senior or Junior?
ADDRESS:
POSTAL CODE: PHONE:
EMAIL: FAX:
Stable Affiliation:

AGREEMENT FOR ACCEPTANCE OF

RISK & WAIVER OF LIABILITY

I understand that the sport of horses is a high risk sport & that I am participating at my own risk & in full knowledge that there is some element of risk that an accident could occur & result in injury or death to the rider or mount.

In consideration of acceptance of this entry or my being permitted to take part in the event, I agree to save harmless and keep indemnified Honey’s Tack N’ Feed and A Taste of Honey Farms Ltd., organizers, and their respective agents, officials, servants and representatives from and against all claims, actions, cost and expenses and demands in respect of death, injury, loss or damage to any person or property however caused, arising out of or in connection with my taking part in this event and not withstanding that the same may have been contributed to or occasioned by negligence of Linda Honey, Edward Honey, their agents, official, servants or representatives. It is understood and agreed that the agreement is to be binding on myself, my heirs and assigns.

I hereby certify that every horse and rider is eligible as entered at this competition. Junior competitors must wear proper fitting, approved protective headgear, with the safety harness correctly secured, at all times while mounted. Approved headgear meets ASTM (American Society for Testing Materials) standards & displays the SEI (Safety Equipment Institute) seal. The British standard, BSI, is also acceptable. It is hereby recognized that all equestrian sports involve inherent risk and that no helmet or protective equipment can protect against all foreseeable injury. I hereby accept this risk and hold harmless the competition, their officials, organizers, agents, employees and their representatives.

I understand that while participating in this high-risk sport, it is recommended that I wear a helmet with a fixed harness while mounted. By not wearing proper safety headgear, I fully accept all responsibilities of my actions.

______

Signature of owner/ agent

I acknowledge as Parent/Guardian of ______that I have read & fully understand & agree with the terms & conditions stated herein on behalf of ______& myself.

______

Signature of Rider (Parent or guardian sign for juniors)

DRESSAGE CLASSES: $15
HUNTER DIVISI ON FEE: $30
CLASS ENTRY FEE: $12 O/F; $10 Flat

If entering by individual class, please circle class

DIVISIONS / CLASSES / ENTRY
FEE
Hunter: Novice / 1. Flat. 2. O/F. 3. O/F
Open / 4. Flat 5. O/F. 6. O/F
Newcomer / 7. Flat 8. O/F. 9. O/F
Beginner / 10. Flat 11. Poles.
FUN / 12. Costume
13. Leadline
14. Hunter Suitability
COMMAND / 15. Walk/Trot
16. Walk/Trot/Canter
17. Horsemanship Open
FUN / 18. Toilet Paper Command
19. Apple Command
20. Ride-A-Buck
STICK PONY
Dressage: Newcomer / 21. Test W/T “B”
Newcomer / 22. Equitation
Novice / 23. Test Training Level “B”
Novice / 24. Equitation
Open / 25. Test First Level “A”
Open / 26. Equitation
Pick-A-Test / 27. Test: ______
TOTAL CLASS/DIVISION FEES
Warm-up Fee: / $10 per round
Late/Post Entry Fee: / $10
Scratch Fee: / $25
TOTAL:
For Office Use Only:
Complete: Paid:
Coggins: Signatures: