2014/2015 WINTER SERIES RIDER HORSE OWNER/AGENT

2014/2015 WINTER SERIES
Please indicate which show this entry is for:
□ November
□ February
Rider Number
Please Note: All riders must
attach photo copies of your
current HCBC membership card
□ March
RIDER
HORSE OWNER/AGENT
TRAINER
SECOND RIDER
Name:
Horse Name:
Name:
Name:
Address:
Age:
Address:
Address:
City:
PC:
HCBC#
Colour:
Sex: M G S
Owner/Agent Name:
Email:
Phone Number:
Ht:
City:
Address:
(
)
Email:
City:
DOB:
PC:
PC:
)
HCBC#
Saturday ~ Jumpers
JUMPER
MEDALS
$25.00
PC:
)
Indicate Classes Being Ridden:
HCBC#
Entry Fee’s
Sunday ~ Hunters
DIVISIONS
$30.00
Check Divisions or circle individual classes $17
City:
Phone Number: (
Phone Number: (
HCBC#
DOB:
DIVISIONS
$40.00
Check Divisions or circle classes $15
INDIVIDUAL OPEN CLASSES
$17.00
Check Individual Classes
LSDSLDKLSDKS
Class Sub Total $
Administration Fee $25.00 Payable by all $25.00
□ Division A .65m Beginner Jumper Classes # 1,2
□ 3 .65m Jumper Medal
□ Division F Ground Poles Classes # 17,18
□20 □21 □22 □23 □24 □25
□ Division B .75m Welcome Jumper Classes# 4, 5
□ 6 .75m Jumper Medal
□ Division G Cross Rails Classes # 30,31,32
LEADLINE FREE CLASS # 19
□ Division C .85m Low Jumper Classes # 7, 8
□ 9 .85m Jumper Medal
□ Division H Oceanside Hunter 2’ (no oxers) Classes # 33,34,35
MEDALS $25.00
□ Division D .9m Open Jumper Classes # 10, 11
□ 12 .9m Jumper Medal
□ Division I Welcome Hunter 2’3” Classes # 36,37,38
□ 26 2’3” Hunter Medal
Stabling $30 day OR $60 2 Days + $50.00 clean stall deposit $
□ Division E .Optimum Ht. Jumper Classes # 14, 15
□ 16 Optimum Ht. Jumper Medal
□ Division J Lantzville Hunter 2’6” Classes # 39,40,41
□ 27 2’6” Hunter Medal
Oceanside Hunter Jumper Membership $20.00 (paid once) $
□ Division K Modified Hunter 2’9” Classes # 42,43,44
□ 28 2’9” Hunter Medal
Non-Member Fee $10.00 $
□ Division L Open Hunter 3’ Classes # 45,46,47
□ 29 3’ Hunter Medal
SPECIAL CLASS
□ Margaret Anne Mini Prix $25.00 Class #13
Hunter Total $
Jumper Total $
By signing this entry form I request permission to participate in horseback riding, showing,
competition and other equestrian, stable and arena activities with Oceanside Hunter Jumpers
Association at Pyramid Stables. I am voluntarily participating in equestrian or other activities with
the knowledge of the danger involved and hereby agree to accept any and all risks of injury or
death. As consideration for being permitted by Oceanside Hunter Jumper Association to
participate in these activities, I agree to indemnify and hold harmless Oceanside Hunter Jumpers
Association and Pyramid Stables, their employees, volunteers or other participant from all claims,
medical expenses, damages, losses, injuries and expenses arising out of or resulting from my
participation in these dangerous horseback riding or related activities. I further agree myself, my
family, heirs, guardians and legal representatives to release, acquit and covenant not to sue, make
or bring any claims of any kind against Oceanside Hunter Jumpers Association, their employees,
volunteers or other participants arising out of or resulting from my participation in these
dangerous horseback riding or related activities. I also agree that if anyone makes a claim because
of any injury to myself (including death) or for any damage to my property, I will keep those
released by this agreement free of any damages or costs because of those claims.
I have carefully read this agreement and fully understand it contents. I am aware
that this is a Release of Liability, a waiver of legal rights and contracts between
me and OHJA, Pyramid Stables & any affiliated organizations. I sign this
agreement and liability of my own free will. I further acknowledge that there are
no warranties either express or implied, concerning the facilities, events or
activates put on by OHJA or Pyramid Stables.
Rider Signature:
Print Name:
Owner/Agent Signature:
Print Name:
Parent Signature:
Print Name:
2nd Rider Signature:
Print Name:
No payment with entry $10.00 $
Late Entry Fee $20.00 $
TOTAL $
METHOD OF PAYMENT
Cash_____ Cheque# _____Visa/MC_____
C.Card #______________________________
Expiry______________CVV#______________
Postal Code of C.Card___________________
Please mail entries to:
Oceanside Hunter Jumper Association
PO Box 1341 Parksville, BC V9P 2H3
Or drop off by the Monday prior to each show at:
Bridles & Bits, Flying Changes Riding School or
Pyramid Stables
`