| Williamsport Riding Children's Show
Entry Form |
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POST |
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| Date
of Show (please circle): May
23rd July 11th Sept. 5th |
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| Name of Rider |
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Age of Rider (Jan 1 st) |
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Name of Horse |
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Breed |
Height |
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| Address |
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Phone |
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Email |
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Division Entered for Points (please circle) |
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| English |
Lead line Mini Stirrup Short Stirrup Long Stirrup Novice Hunter |
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| Western |
Lead line Pee-wee Novice
Junior Senior |
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| Open |
Driving |
Gymkhana(trot/jog) |
Gymkhana
(canter/lope) Walk-Halt Challenged Rider |
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| Class
Numbers Entered |
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| # Classes Entered ___________ x $7.00 per
class = ____________ Please make all checks payable to Williamsport Riding Club |
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| Number
Fee: $5.00 (per
horse/rider/division combination - refundable w/ return of number) |
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Office Use Only |
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| Grounds
Fee: $5.00 (2009 WRC Members
Exempt - Proof of Membership Required.) |
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| Office
Fee: $5.00 |
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Paid |
Check
# _________ or CASH |
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| TOTAL
_______________ |
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Please use separate entry
form for each division entered |
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ALL
RETURNED CHECKS WILL BE CHARGED A $30 FEE PER RETURN |
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| Permission
of minor to show: |
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| I
hereby consent to the entry of my child ______________________________ in the
WRC Children's Show(s) and I hereby accept responsibility |
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| thereunder for the participation of said
minor. I agree that in case of loss or injury involving either horse or
exhibitor, I will make no claims |
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either the show or any individual connected with it. |
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| Signature
of Parent or Guardian _______________________________________ Date _________________ |
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| Photo
Release: |
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| I
hereby consent to the use of my childs' photograph while competing at the WRC
Children's Show to be used by the Williamsport Riding Club in |
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| promotion
of its shows or aknowlegement of winners/champions, including but not limited
to publication in newspapers and on the WRC webpage. |
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| Signature
of Parent or Guardian _______________________________________ Date _________________ |
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