"Albany Horseworld"    
Albany Equestrian Centre Eventing Grand Prix    
Sunday, 22 August 2021    
Entry Form    
(Separate Entry for Each Horse)    
(Closing Date:  16 August 2021)    
Class
   
       
Rider Details      
Rider Name    
Address    
     
Suburb/City    
PostCode    
Mobile Phone    
Email    
       
Rider Club
   
Rider Age Category:
   
       
Horse/Pony Details      
Horse Name    
Owner (if not Rider)    
       
Stallion:
   
       
Emergency Contact at Event:      
Name    
Mobile Phone    
       
       
Helper Duties    
Helper Name    
First Preference
   
Second Preference
   
Helper Experience
   
Helper Age
   
       
Helper Duty - Special Request                 
       
Fees      
Entry Fees    
Camping Fees ($5.00/Night)      
Number of Nights    
Camping Fee    
     
Late Entry Fee ($15)    
       
Helper Fee ($35 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    
       
       
       
       
Dangerous Activity Acknowledgement      
Horse Sports are a Dangerous Activity    
I understand and acknowledge that horse sports are a dangerous activity and     
that horses can act in a sudden and unpredictable way, especially if
 frightened or hurt.
I understand and acknowledge that serious INJURY or DEATH may result from 
horse  sport  activities and in particular from events in which I participate.
I agree that I PARTICIPATE at my OWN RISK.    
Effect of this Document    
I understand that submission of this Entry Form constitutes    
 a complete and  unconditional release of the Equestrian Federation of      
Australia Ltd including all of its state bodies, coaches and Albany Equestrian
Centre Inc, to the greatest extent allowed by law  in the event of me and/or     
the children under my care, suffering injury or death.    
I understand the Albany Equestrian Centre 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.
   
By submitting this Entry Form,  I ACCEPT and  confirm I have    
read and understood the  contents of this disclaimer.