"Albany Horseworld"    
  Albany Equestrian Centre Combined Training    
  Sunday, 12 February 2023    
  Entry Form    
  (Separate Entry for Each Horse)    
  (Closing Date:  6 February 2023)    
  Class
   
         
  Rider Details      
  Rider Name    
  Address    
       
  Suburb/City    
  PostCode    
  Mobile Phone    
  Email    
         
  Parent/Guardian (if rider under 18yrs)    
         
  Rider Club
   
  Rider Age Category:
   
         
  Horse/Pony Details      
  Horse Name    
  Owner (if not Rider)    
       
  Emergency Contact at Event:      
  Name    
  Mobile Phone    
       
       
  Helper Duties (Everyone is responsible for taking arenas down)    
  Helper Name    
  First Preference
   
  Second Preference
   
       
  Helper Duty - Special Request               
       
  Camping?
   
     
       
       
  Fees      
  Entry Fees    
       
  Late Entry Fee ($15)    
         
  Helper Fee ($40 if no helper duty indicated)    
  Total Fees:    
       
Your Entry will not be accepted without payment of the above fee
Direct Transfer
Account Name Albany Equestrian Centre Inc
BSB 633-000
Account Number 143217743
       
  Payment Receipt Details      
  Date    
  Amount    
  Receipt Number    
  Reference    
       
       
       
  Entrant Declaration      
  I, the Rider, agree to participate in the Albany Equestrian Centre's Combined Training Competition  to be held on 12 February 2023.    
  I understand that by submission  of this entry form, I , the Rider, state that I have read and understand this Entrant Declaration, full particulars of which are available on the A.E.C. website at:    
  www.albanyequestrian.net    
   (including the risk warning, indemnity, release and waiver) and agree to the terms and conditions as stated.    
  I understand that the Albany Equestrian Centre does not accept 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 Rider, hereby acknowledge through the submission of this entry form:    
  ·         I have read the whole of this document and understand it.    
  ·         I consent to the Rider 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 Rider is bound by and subject to the rules, regulations, guidelines, policies and codes of conduct of EA, and the Albany Equestrian Centre    
  In consideration of the Rider 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 Rider and agree to personally accept all terms and conditions and obligations set out in this declaration.    
  AGREEMENT ON BEHALF OF ONE PARENT OR GUARDIAN IS AGREEMENT ON BEHALF OF ALL PARENTS AND/OR GUARDIANS OF THE ENTRANT.    
  Parent/Guardian    
  Date