Detersmination Equestrian Center Show Entry Form

Use a separate sheet for each horse/exhibitor combination

Exhibitors Name:   ___________________________________BACK #_______

Age: ____  Birthdate:________________________

Address:______________________________Phone # ________________ email:___________________

Horse’s Name         _____________________________________________      

Registration type and #_________________________________________

Coggins Test #       _____________________________________________

Reminder: An ASTM approved helmet MUST be worn by all youth in All types of riding!

Class entry fee is $5 per class with the exception of Halter Championship = no charge

I agree that I choose to participate voluntarily in this equestrian activity, and by signing the entry blank, I agree and acknowledge that there is serious risk of harm including bodily harm, property damage and even death.  I assume all risks of harm to me, my horse, or my property.  I agree to release Detersmination Equestrian Center and their agents (officials, volunteers, owners, and affiliated organizations) from all claims for money damages or otherwise for any harm to me or my horse and for any harm caused by me or my horse to others, even if the harm is from negligence of Detersmination Equestrian Center.

  Signature of Rider or parent if rider/handler is a minor (Mandatory)_________________________

                                                                                Print name _____________________________

Please enter the class number you are registering for in boxes provided

Number of classes ______X $5 =______                                                                                    Total________

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