"Albany Horseworld"    
  Albany Equestrian Centre Eventing Grand Prix    
  Sunday, 22 September 2024    
  Entry Form    
  (Separate Entry for Each Horse)    
  (Closing Date: 16 September 2024)    
  Class
   
         
  Rider Details      
  Rider Name    
  Address    
       
  Suburb/City    
  PostCode    
  Mobile Phone    
  Email    
         
  Rider Club
   
  Rider Age Category:
   
  Parent/Guardian (if rider under 18yrs)    
         
  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
   
  Where my preferred duty has already been allocated, I understand that a cross country jump judge duty may be allocated to my helper, including where self-help has been mominated.)    
         
  Helper Duty - Special Request                 
  Fees      
  Entry Fees    
  Camping Fees ($5.00/Night)      
  Number of Nights    
  Camping Fee    
       
  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    
       
       
       
  Dangerous Activity Acknowledgement - Entrant Declaration    
  Horse Sports are a Dangerous Activity    
  I agree to participate in the Albany Equestrian Centre Grand Prix Competition to be held on         22 September 2024    
  I understand that by submission  of this entry form, I 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/Waiver%20-%20Events%20-%2022%20Dec    
   (including the risk warning, indemnity, release and waiver) and agree to the terms and conditions as stated.    
  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.
 		   
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.    
  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 RIDER.    
  Parent/Guardian    
  Date