Vancouver Island Appaloosa Horse Club

VANCOUVER ISLAND
APPALOOSA HORSE CLUB

VIApHC ENTRY FORM 2017 Only one horse/rider per entry form

 

 

Rider’s Name: ______________________________________________________________________

Rider’s Age Group (as of January 1st 2017):    11 & Under____     12-14____    15-18____    Senior____

 

Horse’s Name: ______________________________________________________________________

 

Novice Horse: Yes ____ No ____            Novice Rider: Yes ____   No ____

Rider’s Address: ____________________________ City: _________________ Postal Code: ________   

Rider’s Telephone:  _________________________ Rider’s Horse Council # _______________

Owner's Name:_____________________________ Owner's Horse Council # ______________

Coach’s Name: ____________________________ Rider a VIApHC Member:  Yes___  No ___

Classes Entered (please circle): No refunds     (unless illness, injury, lameness- an executive decision will be final)

      Hunter Classes:       1          2          3          4          5          6          7          8          9

 

      Flat Classes:           10        11        12         13         14        15         16         17         18        19        20

                21        22        23         LEADLINE      24         25        26         27         28         29        30       31       

 


Member:                Total # of classes _____ X $ 7.00/class = $ ______

                                                                                                                           


Non - Member:    Total # of classes _____ X $ 10.00/class = $ ______

 

                                                                             Office fee    $     5.00


                                                                                 Ring fee  $ __ 5.00


                                                                                      Total  $_______

If paying by cheque, make it payable to: VIApHC

 

The undersigned gives consent for the above horse & riders’ photographs to be posted on the VIApHC website and Facebook page. (Names will not be used). 

The undersigned agrees that there will be no claim or suit for injury or death, to person(s) or property in connection with participation in this show.  The VIApHC will not be responsible for any accident, injury, loss or property damage that may occur to any entrant, horse or equipment exhibited.  I hereby certify that the horse and rider is eligible as entered, and agree to be bound by the rules of this horse show.

 

Signature of Rider:              _____________________________   Date:______________________________

Signature of Parent/Guardian   ___________________________   Date:______________________________

Signature of horse owner:      ____________________________   Date:______________________________