Williamsport Riding Club Point Show Entry Form

Name of Rider

Age of Rider (Jan 1 st)

Name of Horse

Breed

Height

Address

City

State

Phone

Email

Please Circle Division Entered

Lead Line    Pee-wee    Novice     Junior    Senior

Driving

Class Numbers Entered

Full Lead Line Division  $10.00

Please make all checks payable to Williamsport Riding Club

Full Driving Division $10.00

** All Returned Checks will be charged a $30 fee per Return**

Full Pee-wee, Novice, Junior, Senior Division  $25.00

OR

Number of Classes Entered ___________  X $5.00 per Class = __________

Number Fee:        $5.00 (per horse/rider/division combination - refundable w/ return of number)

Office Use Only

Grounds Fee:       $5.00  (2008 WRC Members Exempt - Proof of Membership Required.)

Paid

Check # _________    or  CASH

TOTAL _______________

Permission of minor to show:

I hereby consent to the entry of my child ______________________________ in this WRC Show(s) and I hereby accept responsibility

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

against either the show or any individual connected with it.

Signature of Parent or Guardian _______________________________________   Date _________________

Minor Photo Release:

I hereby consent to the use of my childs' photograph while competing at this WRC Show to be used by the Williamsport Riding Club in

promotion of its shows or aknowlegement of winners/champions, including but not limited to publication in newspapers and on the WRC web page.

Signature of Parent or Guardian _______________________________________   Date _________________

Hold Harmless Clause:

I hereby  accept responsibility and agree that in case of loss or injury involving myself or equine, I will make no claims against either the show or any

individual connected with it.

Signature  _______________________________________   Date _________________