2010 Entry Form

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Date of Show:_____________________________

Rider Name _______________________________

Street _______________________________

City, Zip _______________________________

Phone Number _______________________________

Stable Name _______________________________

Division Showing In _______________________________

Horse's Name _______________________________

Rider Number _______________________________

Agreement: I understand that my entry is made at my own risk, and that Wm. R. Heberle Stables, Inc. or Blue Fox Farm or employees, trainers, helpers assume no responsibility whatsoever for accidents, damage, injury, or illness to horses, owners, riders, employees, or property owners in connection with this horse  attendants, or any other person show. I agree to hold the above mentioned stables and their agents harmless for any loss, accident or injury that may occur in connection with this horse show, and will make no claim therefore.

Payment

Total # of Classes: _________________

X $12 per class: _________________

Trainer's fee ($30): _____$30.00_____

EMT Fee: _________________

Total Due: _________________

Paid Check #_________________

Paid Cash$_________________

Rider Signature_______________________________________________
Date_________________

Parent/Guardian Signature(If under 18 years of age) _______________________________________________
Date_________________

Last Updated: Saturday, January 23 2010 @ 12:02 PM EST|Hits: 879