Please mark the classes you want to enter for this horse/rider combination. Additional forms should be used for additional horse/rider combinations. Please note the specifications for cross entering.
Pleasure Division Classes*Choose only one of the divisions below
*You may cross enter into any of the Open Classes in the following columns / Open Classes
*You may enter Open Classes in addition to Division classes and Speed/Games / Speed/Games
*Choose the appropriate division below
*May cross enter into Pleasure Division and Open Classes
Lead Line- 7 yrs & under
(3) Equitation- 100% Rider
(4) Pleasure- 50% Horse/50% Rider
(5) Pleasure- 100 Horse / Grooming & Showmanship
(1) 17 Yrs & under
(2) 18 Yrs & over / Walk/Jog
*For Horse/Riders that are not showing in any classes that require a lope (with the exception of Go As You Please as noted for Novice classes)
(34) Bareback -Ride a Buck
(36) Saddled Ride a Buck
(38)Egg & Spoon
(40) Ribbon Pairs
(42) Musical Sacks
(44) Sack Race
(46)Flags
(48) Plug Barrel
(50) Barrels
(52) Poles
Walk/Jog 10 yrs & under
(6) Pleasure
(7) Equitation
(8) Patten Class / Walk Jog Open Division
(9) Pleasure
(10) Equitation
(11) Pattern Class
Novice Horse
(12) Pleasure
(13) Go As You Please
(14) Equitation / Working Ranch Horse
(24) Working Ranch Horse
(25) Western Riding
(26) Discipline Rail
Jack Benny Division
(27) Walk Jog Pleasure
(28) Walk Jog Equitation
(29) Do As You Please
Novice Rider
(15) Pleasure
(16) Go As You Please
(17) Equitation / Trail In Hand
*May not cross enter into Trail Under Saddle
(30)Trail In Hand
Junior Division 11-17 yrs
(18) Pleasure
(19) Go As You Please
(20) Equitation / Trail Under Saddle
*May not cross enter into Trail In Hand
(31) 17 yrs & under
(32) 18 yrs & over / Walk/Jog/Lope
*For Horse/Riders showing in classes that require a lope.
(35) Bareback -Ride a Buck
(37) Saddled Ride a Buck
(39) Egg & Spoon
(41) Ribbon Pairs
(43) Musical Sacks
(45) Sack Race
(47) Flags
(49) Plug Barrel
(51) Barrels
(53) Poles
Adult Division 18 yrs & over
(21) Pleasure
(22) Go As You Please
(23) Equitation / Command Break And Out
(33) Command
Members: $7.00 per Class
Non-Members: $10.00 per Class
Number of Classes ______X $______= ______
Admin. Fee per horse _____$5.00
Total Due______
Check #______
Cash
If you are competing on more than one horse, please complete a separate registration form for each horse.
Date of Show You are Participating In ______/______/______PWHA Member? Yes No
Rider’s Name______Date of Birth______/______/______
Address: ______
City: ______State:______Zip:______Phone:______
Email: ______
***Required*** Copy of Current Coggins Within 12 months. Must be attached and kept on file.
Owner Name: ______Coggins Date: ______/______/______
Owner Address: ______Accession #:______
Owner City: ______State: ______Zip: ______
Horse Name on Coggins: ______Show Name: ______
RELEASE OF LIABILITY
I FULLY ACKNOWLEDGE AND UNDERSATND that horseback riding is an athletic event that poses potentially serious risks of injuries or death to its participants and that my horse or I may be injured or die as a result of my negligence, the negligence of others, or through the fault of myself or anyone else, because of the nature of the activity in which I am going to be engaged and that horses, even the best trained, are often unpredictable.
With this waiver I accept notice of the provisions of Section § 3.2-6200 through § 3.2-6203 (as amended) of the Code of Virginia, which sates in part: "Intrinsic dangers of equine activities" means those dangers or conditions that are an integral part of equine activities, including: (i) the propensity of equines to behave in ways that may result in injury, harm, or death to persons on or around them; (ii) the unpredictability of an equine's reaction to such things as sounds, sudden movement, and unfamiliar objects, persons, or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals or objects; and (v) the potential of a participant acting in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the equine or not acting within the participant's ability. The waiver shall remain valid unless expressly revoked by the undersigned or parent or guardian of a minor, in writing, with receipt acknowledged by Prince William Horse Association and its officers.
I FULLY ACKNOWLEDGE AND UNDERSTAND that I am completely responsible and assume all risks for anything that happens to me and/or my horse while engaged in any equine activity operated, sponsored or supported by the Prince William Horse Association (the “Equine Activity Sponsor”) on/at the Equine Activity Sponsor’s facility or event. For the sole consideration of participating in any activity of the Prince William Horse Association, the undersigned herby releases and forever discharges the Prince William Horse Association, it officers, directors, members and landowners upon whose property an accident or loss may occur, their heirs, successors, executors, administrators, agents, and assigns, and all other persons, firms or corporations liable or who might be claimed to be liable, none of whom admit any liability, but all expressly deny any liability from any and all claims, demands, damages, actions, causes of actions or suits of any kind or nature whatsoever. The Prince William Horse Association and its members, directors, officers, and volunteers are in no way responsible for any injuries, damages or losses that may occur.
I HAVE READ AND UNDERSTAND THE ABOVE LIABILITY RELEASE
______
Rider’s SignatureParent/Guardian’s Signature (for riders under 18 years of age)Date