Touch Point Farm ShowEntry Form

Show Date: ______Please use one form for each horse/rider combination

ENTRYINFORMATION
Waiver (on back) must be completed and signed to receive numbers.
All horses must show a current negative Coggins. / CLASSES
CHECK ALL THAT APPLY AND CIRCLE FENCE HEIGHTS
Small Ponies jump 2’ Med Ponies jump 2’3”
Large ponies and horses jump 2’6”
Division will be split/combined if entries warrant.*
Rider Name:
Address:
Phone:______
E-Mail:______
Rider VHSA #
______ Circle: Junior / Adult
Horse______
Horse VHSA #______ Circle: Horse / Sm Pony / Med Pony / Lge Pony
Owner:
________
Owner VHSA #
______
Trainer:______
Trainer Phone:_
Trainer E-Mail:______
Coggins Date: ______
State:______
Accession # / Low/Schooling Hunter*: open to horses and ponies. No restrictions on riders. Low to jump 2’, Schooling 2’6
1. Low/Schooling Hunter O/F (2’, 2’6)
2. Low/Schooling Hunter O/F (2’, 2’6)
3. Low/Schooling Hunter U/S
4. VHSA Child/Adult Eq O/F 2’6 or 3’
VHSA Children’s/Adult Hunter: Open to Juniors or Adult Amateurs on horses
5. Child/Adult - OF
6. Child/Adult - OF
7. Child/Adult – U/S
VHSA Working Hunter: Open to all riders & Horses. Fences 3’
8. Working Hunter – O/F 3’
9. Working Hunter – O/F 3’
10. Working Hunter – U/S
11.VHSA Equitation on the Flat
VHSA JR./ADULT PLEASUREHORSE*
12. Walk/Trot
13. Go-as-you-please
14. Walk/Trot/Canter
Schooling Break (30 minutes) / 15. Leadline 50% Rider 50% Pony
Pre-short Stirrup Equitation: Open to riders 10 and under. May not cross-enter any class that canters or jumps.
16. Pre-short Stirrup Walk
17. Pre-short Stirrup Walk/Trot
18. Pre-short Stirrup Walk/Trot/Obstacles
VHSA Short Stirrup Equitation: Open to riders 12 and under. Riders may not cross-enter classes where jumps exceed18”.
19. Short Stirrup Walk/Trot
20. Short Stirrup Walk/Trot/Canter
21. Short Stirrup O/F 18”
VHSA Pleasure Pony Open to ponies ridden by juniors.
22. Pleasure Pony Walk/Trot
23. Pleasure Pony Go-as-you-please
24. Pleasure Pony Walk/Trot/Canter
25. VHSA Pony Equitation O/F Open to Ponies ridden by Juniors. At least ¼ of class to return for Flat.
VHSA Pony HunterOpen to ponies ridden by Juniors. Small ponies to jump 2’, Med. 2’3, Lg 2’6.
26. Pony Hunter O/F
27. Pony Hunter O/F
28. Pony Hunter U/S
29. WARM-UP Course B.

<small<small>RELEASE AND HOLD HARMLESS AGREEMENT

The Undersigned assumes the unavoidable risks inherent in schooling/showing horses and other horse-related activities, including but not limited to bodily injury and physical harm to horse, rider, and spectator.

In consideration, therefore, for the privilege of riding, horse boarding, receiving riding instruction, schooling,showing, and/or working around/with horses at Touch Point Farm (16251 Dark Horse Trail, Culpeper, Virginia), or other equestrian facility assigned (including trailering and personal transportation to said facility), the Undersigned does hereby agree to hold harmless and indemnify Touch Point Farm, LLC, Peter R. Janet B. Schwenke, farm owners, Meredith Jones, instructor, outside instructors, and/or their assigns, & further release them from any liability or responsibility for accident, damage, death, injury, or illness to the Undersigned and his/her child/children, or to any horse owned, ridden, schooled, shown and/or boarded by the Undersigned or to any other family member or spectator accompanying the Undersigned on the premises.

I, the Undersigned person, intending to be legally bound, hereby waive for myself, agents, guardians, heirs, executors, administrators, legal representatives, assigns, and any other persons, any & all rights & claims for damages, demands & any other actions whatsoever which I may have against any of the above named persons or their property, arising out of my equestrian/schooling/showing/boarding activities. I expressly give up my right to sue any/all above named persons/entities.

By my signature, I acknowledge that I understand the above, and that handling and/or riding horses is considered a hazardous activity & that there are inherent risks, including (i) the propensity of an equine to behave in dangerous ways which may result in injury or death to the participant; (ii) the inability to predict an equine’s reaction to sound, movements, objects, persons, or animals; and (iii) hazards of surface or subsurface conditions. I assume full liability for any personal injury, death or property damage to my person, child/children, persons accompanying me, personal property and horse(s).

See Code of VA.Virginia Equine Activity Liability Act, Sec. 3.2-6200 through 6203. 10/1/08.)..as it may now provide or be hereafter amended([the”Act”). All terms defined by the Act shall have the same meaning herein, and this Act is hereby incorporated in the Agreement by reference. This Agreement shall be so construed as to provide to the sponsor/professional the fullest protection of a release, waiver or right to sue and assumption of all intrinsic dangers which is afforded to the sponsor/professional by the Act and by general law. Additionally, I specifically authorize Peter R. Schwenke, Janet B. Schwenke, Meredith Jones, and/or their assigns, to seek professional medical assistance, at my expense, for ______, should they feel it is in his/her/their/its best interests.

SAFETY HELMETS REQUIRED WHEN MOUNTED.

The waiver shall remain valid unless expressly revoked in writing by the participant or parent or guardian of a minor. (1991, c.358; 2003, c. 876)

DATE: ______REASON ______

<div align="Center"<div align="Left">PRINT NAME OF PARENT OR LEGAL GUARDIAN______

SIGNATURE OF PARENT/GUARDIAN FOR MINOR CHILD______

NAME OF MINOR CHILD/REN______

ADDRESS______

PHONE: ______E-MAIL:______

NAME OF EMERGENCY CONTACT ______PHONE #______

NAME OF MEDICAL INSURANCE & POLICY #______