GOLDSHOWENTRYFORMPlease completeoneformper horse enteredPg.1/2

NameofRider

OEF/PSONo.ECNo.

IsRideraJunior (17orunderasofJanuary1,2017)? Yes OR Yes,AdultAmateurperECruleA902?

D.O.B if Jr. (Y/M/D)

Photocopies ofCardsEnclosed?(EC/OEF/PSO) Yes No

AddressofRider

TownProvincePostalCode

PhoneNumbers-HomeWork

Email

Name of Horse

Horse Recording no. (EC)/Passportno.(FEI)______Stallion Mare Gelding Pony CogginsEnclosed?Yes No

Ownerinformation:Checkhereifsameasrider

NameofOwner

AddressofOwner

TownProvincePostalCode

PhoneNumbers-HomeWork

OEF/PSONo.ECNo.

E-mail

IfaTrainer/Agent isactingonbehalfofanOwner,theTrainer/Agent mustfillintheinformationabovefortheowner

Name of Trainer/Agent

OEF/PSONo.ECNo.

SignatureofTrainer/Agentx

StableaffiliationTravellingwith

Liability Waiver

I hereby certify that every horse and rider is eligible as entered and agree for myself and my representatives to be bound by the Constitution and Rules of Equine Canada at this competition. 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 EC, the competition, their officials, organizers, agents, employees and their representatives. The Person Responsible (PR) agrees to the release of any information on the entry form to EC.

In the event that participates in an Equine Canada sanctioned competition where protective headgear is required for juniors, he/she will wear a properly fitted, and fastened approved headgear at all times while riding at the event location. It is understood that juniors not meeting this requirement will not be allowed to compete at these competitions.

While on the premises, I/we agree to be bound by the rules of Equine Canada and any rules, regulations or directives of Rainbow Ridge Ranch relating to this competition.

Signature of Rider (or Parent/Guardian if Junior)

Print NameDate

Signature of Owner (if different from rider)

Print NameDate

Signature of Person Responsible for HorsePrint Name

Sport License #Date

(Rider or Parent/Guardian per EC Regulation A1011 – Coach must not sign in lieu of parent or legal guardian.)

Note: Release from Liability While On Premises must be signed by both rider (parent/guardian if Junior) and owner.

For your entry to be valid, all documents and payments must be received at the office before the closing date.

GOLDSHOWENTRYFORMPlease completeoneformper horse enteredPg.2/2

RAINBOWRIDGERANCH

Gold Dressage Competition

July 8-9, 2017

SATURDAY – Table A / Class / JR / AA / O / $ / TOTAL
WalkTrot,TestA / 1 / 50 / $
WalkTrot,Test B / 2 / 50 / $
WalkTrot, / 3 / 50 / $
Training,Test 1 / 6 / 50 / $
Training,Test 2 / 7 / 50 / $
Training, Equitation: / 11 / 50 / $
First,Test 1 / 12 / 50 / $
First,Test 2 / 13 / 50 / $
First Level Equitation / 16 / 50 / $
Second,Test 1 / 18 / 55 / $
Second,Test 2 / 19 / 55 / $
Third,Test 1 / 23 / 55 / $
Third,Test 2 / 24 / 55 / $
Third, TOC Open Specify Test / 26 / 55 / $
Fourth,Test 1 / 28 / 55 / $
Fourth,Test 2 / 29 / 55 / $
Fourth, TOC Open, Specify Test / 31 / 55 / $
FEI Children Preliminary / 33 / 65 / $
FEI ChildrenTeam / 34 / 65 / $
FEI Children TOC Specify: / 36 / 65 / $
FEI PonyTeam / 37 / 65 / $
FEI JRTeam / 40 / 85 / $
FEI JR TOC Specify Tests / 43 / 85 / $
FEIYRTeam / 44 / YR / 85 / $
FEIYR TOC Specify: / 47 / YR / 85 / $
FEI TOC (Except GP) – Specify test / 67 / 80 / $
FEI Intermediate 1 / 49 / 85 / $
FEI IntermediateA / 51 / 85 / $
FEI Intermediate II / 53 / 90 / $
FEI Grand Prix U25 / 54 / U25 / 85 / $
FEI Grand Prix / 55 / 90 / $
FEI 4Year Old Test / 58 / 60 / $
FEI 5Year Old Preliminary / 59 / 80 / $
FEI 6Year Old Preliminary / 61 / 80 / $
MaterialeTest (3 & 4Year Olds) / 63 / 60 / $
FEI EC Para- Equestrian, TOC
Specify: / 64 / 75 / $
Total Saturday: / $
Stallion Mare Gelding Height:
STABLING (Please phone 613-821-2939 to confirm availability) – Table C
Full Show (Friday pm, Saturday & Sunday) / $160.00 / $
Full Show, Stabling in main barn, as available / $200.00 / $
Day Stall only / $80.00 / $
Tack stalls – same price as above, if available / $
H2O bucket if needed - $5.00; Shavings Shavings: Qty: / $8.00 per bag / $
Total Stabling: / $
*See Stabling in Price List for more information / SUNDAY – Table B / Class / JR / AA / O / $ / TOTAL
WalkTrot,Test D / 4 / 50 / $
Walk Trot - TOC / 5 / 50 / $
Training,Tests 2 / 8 / 50 / $
Training ,Test 3 / 9 / 50 / $
Training, TOC – Open Specify tests / 10 / 50 / $
First,Test 3 / 14 / 50 / $
First, TOC OpenSpecify Test / 15 / 50 / $
EC First Level Freestyle Open / 17 / 50 / $
Second,Test 3 / 20 / 55 / $
Second, TOC Open Specify Test / 21 / 55 / $
EC Second Level Freestyle Open / 22 / 60 / $
Third,Test 3 / 25 / 55 / $
EC Third Level Freestyle Open / 27 / 55 / $
Fourth,Test 3 / 30 / 55 / $
EC Fourth Level Freestyle Open / 32 / 55 / $
FEI Children Individual / 35 / 65 / $
FEI Pony Individual / 38 / 65 / $
FEI Pony Freestyle / 39 / 70 / $
FEI JR TOC / 65 / 85 / $
FEI TOC (Except GP) Specify test / 68 / 80 / $
FEIJR Individual / 41 / 85 / $
FEI JR Freestyle / 42 / 80 / $
FEI YR Individual / 45 / YR / 85 / $
FEIYR Freestyle / 46 / YR / 85 / $
FEI YR TOC / 66 / 85 / $
FEI Prix St-Georges / 48 / 80 / $
FEI Intermediate 1 Freestyle / 50 / 80 / $
FEI Intermediate B / 52 / 85 / $
FEI Grand Prix, GP Special / 56 / 90 / $
FEI Grand Prix Freestyle / 57 / 80 / $
FEI 5Year Old Finale / 60 / 80 / $
FEI 6Year Old Finale / 62 / 80 / $
FEI Para- Equestrian, TOC Open / 65 / 75 / $
Total Sunday: / $
FEE CALCULATION
Total Saturday / from table A / $
Total Sunday / from table B / $
Total Stabling / from table C / $
Non participating horse / $ 50 / $
Administration / $ 45 / $ 45
DrugTesting Fee / $ 7 / $ 7
Late entry / $ 50 / $
SUB TOTAL / $
HST on above items Total HST / $
SUB TOTAL / $
Dressage Canada Levy / $ 10 / $ 10
COMPETITION TOTAL / $
Pay to Rainbow Ridge Ranch (Cheque or e -Transfer- )