Albany Agricultural Show    
  Dressage Competition    
  Sunday, 13 November 2022    
  Entry Form    
  Entries Close:  6th November 2022    
         
  Competitor/Participant/ Restricted 
   
         
  Rider Details      
  Rider Name    
  Address    
       
  Suburb/City    
  PostCode    
  Mobile Phone    
  Email    
  Parent/Guardian (if rider under 18yrs)    
         
  Rider EA Number  
  Young Rider
   
  Rider Age Category:
   
         
  Horse/Pony Details      
  Horse Name    
  Horse EA Number  
  Horse Bridle Number  
  Owner (if not Rider)    
         
  Stallion
   
  Pony
   
       
  Emergency Contact      
  Name    
  Mobile Phone Number    
         
  Helper Duties    
  Helper Name    
  First Preference
   
  Second Preference
   
         
  DRESSAGE TESTS      
  Classes: To enter please indicate  'X' alongside the particular test    
         
  EA_Prep_Test_C    
  EA_Prep_Test_E    
  EA Preliminary 1B    
  EA Preliminary 1C    
  EA Novice 2B    
  EA Novice 2C    
  EA Elementary 3B    
  EA Elementary 3C    
  EA Medium 4B    
  EA Medium 4C    
  EA Advanced 5B    
  EA Advanced 5C    
  Prix St Georges    
  Intermediate 1    
  Para Tests - Enter Test Below    
     
     
  Total Tests    
         
         
  Fees      
         
  Tests: Number of Tests  
  Entry Fees ($28/test)    
  Ground Fees ($10/horse)    
  Day Membership Fee    
  Late Entry Fee    
  Total Fees:    
       
Your Entry will not be accepted without payment of the above fee
Direct Transfer
Account Name Southern Districts Dressage Club
BSB 036-168
Account Number 15-8842
       
  Payment Receipt Details      
  Date    
  Amount    
  Receipt Number    
  Reference    
       
  Entrant Declaration      
  I, the Entrant, agree to participate in the Southern Districts Dressage Club's and the Albany Agricultural Society's dressage competition to be held on Sunday, 13 November 2022.    
  I understand that by submission  of this entry form, I , the Entrant, state that I have read and understand this Entrant Declaration, full particulars of which are available on the S.D.D.C. website at:    
  www.sddc.org.au/Waiver%20-%20Events%20-%2022%20Dec.pdf    
   (including the risk warning, indemnity, release and waiver) and agree to the terms and conditions as stated.    
  I understand that neither the Southern Districts Dressage Club nor the Albany Agricultural Society accets any liability for the loss of, or damage to, vehicles, or any other goods or articles, and does not offer any personal insurance to riders.
 		   
  Name    
  Date    
  My Emergency Contact for the activity    
  and they can be contacted on:    
       
Third party indemnity where participant is under 18 years of age
  I,    
  being the parent/guardian of the Entrant, hereby acknowledge through the submission of this entry form:    
  ·         I have read the whole of this document and understand it.    
  ·         I consent to the Entrant participating in the Equestrian Activity.    
  ·         I am aware of the risks, dangers and obligations set out in the E.A. Waiver of Events (2022) document.    
  ·         I acknowledge that the Entrant is bound by and subject to the rules, regulations, guidelines, policies and codes of conduct of EA, the Southern Districts Dressage Club and the Albany Agricultural Society    
  In consideration of the Entrant being accepted as a participant in the Equestrian Activity I hereby indemnify and release the Organiser/s and the Associate/s in the same manner and to the same effect as if I was the Entrant and agree to personally accept all terms and conditions and obligations set out in this declaration.    
  AGREEMENT ON BEHALF OF ONE PARENT OR GUADIAN IS AGREEMENT ON BEHALF OF ALL PARENTS AND/OR GUARDIANS OF THE ENTRANT.    
  Parent/Guardian    
  Date