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Albany Agricultural
Show
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Dressage
Competition
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Sunday, 14 November
2021
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Entry Form
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Entries Close:
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5th November 2021
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Competitor/Participant/ Restricted
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Rider Details
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Rider Name
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Address
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Suburb/City
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PostCode
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Mobile Phone
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Email
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Rider EA
Number
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Young Rider
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Rider Age Category:
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Horse/Pony Details
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Horse Name
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Horse EA Number
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Horse Bridle Number
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Owner (if not
Rider)
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Stallion
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Pony
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Helper Duties
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Helper Name
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First Preference
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Second
Preference
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DRESSAGE TESTS
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Classes: To enter
please indicate 'X' alongside the
particular test
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EA_Prep_Test_C
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EA_Prep_Test_E
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EA
Preliminary 1B
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EA Preliminary 1C
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EA Novice 2B
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EA Novice 2C
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EA Elementary 3B
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EA Elementary
3C
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EA Medium 4B
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EA Medium 4C
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EA Advanced
5B
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EA Advanced
5C
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FEI Para V
Team
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FEI Para V
Individual
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Total Tests
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Fees
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Tests: Number of Tests
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Entry
Fees ($28/test)
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Ground Fees ($10/horse)
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Day Membership Fee
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Late Entry Fee
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Total Fees:
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Your Entry will
not be accepted without payment of the above fee
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Direct Transfer
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Account Name
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Southern Districts Dressage Club
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BSB
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036-168
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Account Number
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15-8842
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Payment Receipt Details
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Date
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Amount
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Receipt
Number
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Reference
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Dangerous Activity
Acknowledgement
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Horse Sports are a Dangerous Activity
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I understand and acknowledge that horse sports are a dangerous
activity and
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that horses can act in a sudden and unpredictable way,
especially if
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frightened or hurt.
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I understand and acknowledge that serious INJURY or DEATH may
result from
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horse sport activities and in particular from events in
which I participate.
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I agree that I PARTICIPATE at my OWN RISK.
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Effect of this Document
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I understand that submission of this Entry Form constitutes
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a complete and unconditional release of the Equestrian
Federation of
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Australia Ltd including all of its state bodies, coaches,
Albany Agricultural
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Society and Southern
Districts Dressage Club,
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to the greatest extent
allowed by law in the event of me
and/or
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the children under my care, suffering injury or death.
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I understand the Albany Agricultural Society and
Southern Districts Dressage Club accepts no liability for the loss of,
or damage to, vehicles, or any other goods or articles, and does not offer
any personal insurance to riders.
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By submitting this Entry Form,
I ACCEPT I confirm having
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read and understood the
contents of this disclaimer.
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