Gisborne Pony Club Inc. 001331L
HORSE TRIALS PROGRAM
17th MARCH 2013
SUNDAY, 17th MARCH 2013
Grade 2 Qualifier for State Horse Trials (subject to accreditation).
I.R. Robertson Reserve 340 Couangalt Rd, Gisborne South.
Enquiries: Event secretary Kylie Hutchison/Sue Hollins available on event mobile number 0498 683 864
Zone Representative: Leonie Lang ph 03 54 282 717
Event email:
ENTRY FEE: $40.00. Sashes to 6TH PLACE and Rosettes for Best Dressage in all grades.
PONY CLUB GRADES / OPEN SECTIONS / PCAV DRESSAGE TEST (July2006)Available on the PCAV website / MAX HEIGHT
GRADE 2 / GRADE 2 / 2HT1 (60 x 20 arena) / 0.90m
GRADE 3 / GRADE 3 / 3C (60 x 20 arena) / 0.75m
GRADE 4 / GRADE 4 / 4C (40 x 20 arena) / 0.60m
GRADE 5 / GRADE 5 / 5C (40 x 20 arena) / 0.45m
PLEASE NOMINATE VOLUNTEER TO ASSIST AS A CROSS-COUNTRY FENCE STEWARD.
ENTRIES CLOSE WEDNESDAY, 6TH MARCH 2013
TO ENTER: Send entry form, Competitors Declaration Form, Day Attendance form (if entering open), payment (via direct debit or cheque made payable to Gisborne Pony Club Inc) and a stamped self-addressed envelope or email address to:
e-mail address:
Including scanned in, signed Competitor Declaration Form and Day Attendance form and receipt number of Direct Debit transaction.
Or Post to: Gisborne Pony Club Horse Trials Entry, PO Box , Gisborne Vic 3437.
Conditions of Entry:
Entry is conditional upon acceptance of these conditions:
1. Entry Fee is $40 per entry. Before riding:
a. PCAV club member cards must be inspected at the secretary’s office.
b. All open competitors must sign a DAY ATTENDANCE form and if a current pony club card cannot be presented pay an additional $10.
2. No refunds after closing date except with vet or medical certificate. An admin fee of $10 will be deducted.
3. Entries are accepted in order of receipt until sections are full. In the event that excess entries are received a waiting list will be created and advised. Late entries will only be accepted at committee discretion if places are available.
4. Entering this competition constitutes acknowledgement that PCAV rules apply and acceptance of these rules.
5. The organising committee reserves the right to cancel any class or competition; divide any class; alter times; refuse any entry with or without stating the reason.
6. Competitors may ride more than one horse, subject to the conditions of PCAV Handbook of By-laws multiple horse rules.
7. Complying helmets must be worn, spot checks may occur.
8. Gear Check: required for all riders before each phase.
9. Armbands: must be worn by all competitors.
10. Riders must be at least eight years of age, horses must be at least four years of age, no stallions, colts or rigs.
11. Competitor numbers - the organising committee will pre-allocate and advise numbers. Competitors may supply their own numbers. However, body numbers must be used for cross-country. Body numbers will be available at the event.
12. PCAV Alcohol Policy applies.
13. Dogs are prohibited without exception.
14. Queries, protests, horse abuse, rules as per the PCAV Handbook of By-Laws.
15. This event will comply with the PCAV EI and Biosecurity Guidelines which are current at the time of the event.
16. Neither the organising committee of this competition nor the PCAV accepts any responsibility whatsoever for any accident, damage, injury or illness to horses, riders, ground spectators or any other person or property.
17. Lungeing only permitted in allocated area
6
Gisborne Pony Club Inc. 001331L
HORSE TRIALS PROGRAM
17th MARCH 2013
ENTRY FORM – PER RIDER
Contact Name:Address:
Postal Address if different to above:
Email address:
Phone number:
Mobile number:
Riders Name:
Pony Club:
Fence Steward (required):
Fence Steward Phone number or email address:
Do you have any additional requirements or time requests? Ie siblings riding on the day (best efforts will be made but cannot be guaranteed)
Horse 1 / Grade / $40 Fee / $10 Day Attendance
Total Fee Horse 1
Horse 2 / Grade / $40 Fee / $10 Day Attendance
Total Fee Horse 2
If additional horses please add extra page.
Total Fee for Rider / $Cheque enclosed / c OR/
Direct Deposit made to
Account Name: Gisborne Pony Club Inc
BSB: 633-000
Account number: 12-342-3774
PUT SURNAME AS REFERENCE / c
Direct Deposit Date and Receipt Number :
ENTRY CHECKLIST
Completed Rider and Horse Form / cPayment Made / c
Competitor Declaration Form / c
Day Attendance Form all open entries / c
Stamped self addressed envelope enclosed / c
or email provided for draw / c
COMPETITOR DECLARATION FORM – TO BE COMPLETED BY ALL RIDERS
Event Name: GISBORNE PONY CLUB HORSE TRIALS
Date: 17th MARCH 2013
Biosecurity is a condition of participation in our Club’s event. Please complete and sign this form and post to the event secretary along with your entry form and fee. In the event of an outbreak of disease, such as EI, it is crucial that we can track down every horse that has taken part in our event. To do that we need to record where they will have come from and their destinations thereafter.
Registered Name of Horseand/or name as officially entered / Address of property from which the horse will be moved to come to this event. / Address of property to where the horse will move after the event. (If different from origin.)
Health of Horse (s)
I declare that the horse named above will be in good health, eating normally and not showing signs of respiratory disease during the last 3 days leading up to this event. I give my authorisation for the Event Secretary to call for veterinary inspection of the horse/(s) named above and in my care should they be showing signs of respiratory illness at any time during the course of the event. I agree to pay any veterinary fees incurred as a result of this veterinary examination.
Horse Event Declaration Waiver
I understand that due to diseases such as equine influenza, the Victorian DPI, or other State or Commonwealth government body, may restrict or prevent the movement of horses, vehicles and personnel for a period of time (‘Standstill.’). I acknowledge and agree that a Standstill is a risk of competing at this event and I agree to pay all costs or expenses as a result of a Standstill.
Biosecurity Guidelines
I have read and understand the PCAV Biosecurity Guidelines on the website www.ponyclubvic.org.au and I will act in accordance with these guidelines.
Refund Policy
I understand that the Gisborne Pony Club Inc will refund all entry fees if the event is cancelled prior to the closing date of the event. If the event is cancelled after the closing date, the organisers will refund the value of already incurred expenses. However, if there is an equestrian event standstill implemented during the event, and the event is cancelled due to an EI outbreak in Victoria, entry fees will not be refunded.
Signature of Person Responsible for Horse: ______(Parent/Guardian to sign for riders under 18).
Person who will transport the Horse (if different from above):
Name: ______
Phone/Mobile: ______
Day Attendance Application for Open Sections
Who signs the form: All open section participants must complete one of these forms before riding.
Who pays $10: Non-pony club members must pay $10 per day of participation.
Pony club members (PCAV and Interstate) do not pay the fee providing they
present their pony club card to prove they are current club members.
If a pony club card is not presented, the $10 fee must be paid.
There is no personal accident cover for non-pony club members but there is Public Liability cover.
Ensuring this form is completed fulfills Bylaw 29 and enables the Club to be covered by Public Liability
Competition Details
Name of Pony Club Hosting this Event:
Competition/Activity Name:
Competition Venue/Address:
Competition Dates: From ………………………………………. To ………………………………… Inclusive
Attendee Details
Full Name (Participant):…………………………………………………………………………………………………….
Full Name (Guardian if participant under 18years): .
Address: ……………………………………………………………………………………………………………………..
Suburb/Town: ……………………………………………………………….…. State:…………. Postcode: ………...
Participant Date of Birth: ………………………………………………….……. Age: …………..….
Best Daytime Contact Phones: …………………………………………….……………………………………………
Email: ………………………………………………………………………………………………………………………..
Horses Names: …………………………………………………………………….…………………………………….…
Address horse travelled from/to:
Vehicle/Float Reg No… Vehicle Type: ……………………………………………..
Page 2 must always be completed and page 3 for all non-pony club members
ORGANISING COMMITTEE USE ONLY
Day Attendance fees paid $……………………..………………. Receipt No………………………………………..
Name of event secretary/nominee collecting form: ……………………………………………………………………
Signature: ………………………………………………………………..…………………. Date:………………………
$10 fee per day: payable by anyone who cannot present a current pony club member card.
The host club must remit all the fees collected as one cheque plus, an official Day Attendance Summary form to the PCAV State Office,73-75 MACKIE RD, MULGRAVE. VIC. 3170 within seven working days.
Organising Committee Statement of Riding Requirements
The organising committee must state what riding requirements (specifications) apply for each grade/class/section of the competition/activity. The specifications must be detailed on the entry information before accepting an entry. The statement must advise: -
A) Which grade the specifications will be equivalent to, if applicable
B) Maximum jump heights and spreads, if applicable
PCAV Club Members and Interstate Pony Club Members
· Must sign a Day Attendance form when participating in an open section/activity
· No day attendance fee is applicable
· The ‘grade/riding specification’ selected by a pony club member in an open section may be different to the grade(s) on the PCAV club member card, providing they declare by signing, that they are competent to do so.
· Pony club members may ride in an open or a pony club section on the same mount except in horse trials.
Non-Pony Club Members
· Must sign a Day Attendance form
· Must pay $10 per day (i.e. $20 if the event runs over two days)
Participant Agreement and Declaration of Competency
I, the Participat or I the Guardian if participant is under 18 years of age, declare and agree that -
1. The Participant and Guardian (if applicable) understand the requirements for the competition/activity including any jumping heights/spreads.
2. The Combination (horse and rider) is competent and sufficiently experienced to complete the competition/activity in a safe manner.
3. The Participant and Guardian (if applicable) will inspect all relevant riding arenas, jumping and/or cross-country courses prior to riding and will withdraw from the competition/activity if upon inspection, the Combination’s level of competency and experience is not suited for the competition/activity.
4. If withdrawing from the competition, the combination may ride in another section/grade only at the organising committee’s discretion and if they can be accommodated without inconvenience. If withdrawing without participation, there is no obligation to refund incorrect entries.
5. I/we will abide by the PCAV rules, policies and codes whilst attending the pony club competition/activity.
6. At this competition/activity, I am competent to enter into (tick applicable boxes and complete details): -
q Dressage Grade//Section(s) ………………………………………………………………………………
q Showjumping Grade/Section(s) ……………………………………………………………………..……..
q Other …………………………………………………………………………………………………………..
Participant if over age 18 or Guardian signature:…………………………………………………………… Date:……………….
Waiver – non-pony club members
(Applicable for anyone who cannot present a current pony club member card)
In consideration for being permitted to participate in any way in horse sport activities and in particular this event, I, the undersigned, understand, acknowledge and accept that:
Horse sports are a dangerous recreational activity and horses can act in a sudden and unpredictable (changeable) way, especially if frightened or hurt.
There is a significant risk that serious INJURY or DEATH may result from horse sport activities and in particular this event.
I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of Pony Club Association of Victoria Inc and/or the event organiser (hereafter referred to as the "Releasees") or others and I voluntarily PARTICIPATE at my OWN RISK and assume sole responsibility for any injury, death or property damage I may suffer that arises from my participation in horse sport activities.
I understand and acknowledge the dangers associated with the consumption of alcohol or any mind altering drugs before and during the activity and I take full responsibility for any injury, loss or damage associated with their consumption. I agree not to drink alcohol or take drugs prohibited by law before or during this event.
I agree to follow the directions of any event organiser or official and that any misconduct or refusal by me to follow any direction of any organiser or official can result in the CANCELLATION of my participation in the event and my immediate removal from my horse NO MATTER where that may occur. I understand that any such non-compliance may result in injury, death and/or permanent disability and I agree to indemnify the Releasees against all claims made by any person as a result of my failure to comply.
I agree to wear a helmet at all times whilst participating in the sport where this is required under the relevant Pony Club rules and regulations and agree that I am solely responsible for ensuring that whilst participating I wear a suitable helmet at all times where required under the relevant Pony Club rules and regulations and take sole responsibility for my actions.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless and agree not to sue Pony Club Association of Victoria Inc and/or the event organiser, their officers, officials, volunteers, coaches, agents and/or employees and/or other pony clubs (all of whom are referred to as "Releasees") with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the releasees or otherwise.
Effect of this Document
I have had sufficient opportunity to read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without inducement of any kind.