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in conjunction
with the Albany Equestrian Centre
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Horemanship/Obstacle
Fun Day
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14th April 2019
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ENTRY FORM
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(Entries Close: 10
April 2019)
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Rider Details
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Rider Name
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Rider Club
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Mobile Phone
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Email
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Age (if rider under 18-years)
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Guardian (if rider under 18-years)
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Horse/Pony Details
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Horse-1 Name
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Horse-2 Name
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Jump Selection
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Challenger Categories
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Juniors
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Seniors
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Fees
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Number of Horses Entered
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Entry Fee: $40 for first horse; $30
for second horse
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Day Membership ($20)
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Late Entry Fee ($10)
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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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Albany Horsemen's Association
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BSB
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066-500
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Account Number
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0080 0052
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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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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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I UNDERSTAND AND ACKNOWLEDGE THE DANGERS RESULTING FROM THE
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CONSUMPTION OF ALCOHOL OR ANY MIND-ALTERING DRUGS WHILE
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RIDING AND I TAKE FULL RESPONSIBILITY FOR ANY INJURY, LOSS OR
DAMAGE
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ASSOCIATED WITH THEIR CONSUMPTION.
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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, PCAWA,
coaches and West
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Plantagenet Pony Club, to the greatest extent allowed by
law in the event
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of me and/or the
children under my care, suffering injury or death.
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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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Rider Name
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Parent/Guardian Acknowledgement (for riders under the age of
18-years)
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This is to certify that I, as a Parent/guardian
with legal responsibility for this participant, acknowledge, understand and
accept ALL OF THE ABOVE and consent and agree to my minor child’s involvement
or participation in horse sport activities.
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