|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dressage Competition Day
|
|
|
|
Saturday, 15 April 2023
|
|
|
|
Entry Form
|
|
|
|
Entries Close:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Competitor/Participant/
Restricted
|
|
|
|
|
|
|
|
|
|
Rider Details
|
|
|
|
|
Rider Name
|
|
|
|
|
Address
|
|
|
|
|
|
|
|
|
|
Suburb/City
|
|
|
|
|
PostCode
|
|
|
|
|
Mobile Phone
|
|
|
|
|
Email
|
|
|
|
|
|
|
|
|
|
Parent/Guardian
(if rider under 18yrs)
|
|
|
|
|
|
|
|
|
|
Rider Club Membership
|
|
|
|
|
|
|
|
|
|
Rider EA Number
|
|
|
|
|
Young Rider (16-21 years)
|
|
|
|
|
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 2
|
|
|
|
|
EA Prep Test 3
|
|
|
|
|
EA Preliminary 1.2
|
|
|
|
|
EA Preliminary 1.3
|
|
|
|
|
EA Novice 2.2
|
|
|
|
|
EA Novice 2.3
|
|
|
|
|
EA Elementary 3.2
|
|
|
|
|
EA Elementary 3.3
|
|
|
|
|
EA Medium 4.2
|
|
|
|
|
EA Medium 4.3
|
|
|
|
|
EA Advanced 5.2
|
|
|
|
|
EA Advanced 5.3
|
|
|
|
|
Prix St Georges
|
|
|
|
|
Intermediate 1
|
|
|
|
|
Total Tests
|
|
|
|
|
|
|
|
|
Camping
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fees
|
|
|
|
|
Tests: Number of Tests
|
|
|
|
|
Entry Fees: (SDDC Members - $30.00/test; Non-SDDC Members - $34.00/test)
|
|
|
|
|
Ground Fees:
(SDDC or AEC Members $5/horse per day;
Non-SDDC or Non-AEC Members $10/horse per day)
|
|
|
|
Ground Fees
|
|
|
|
|
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 Rider, agree to participate in the Southern Districts
Dressage Club's Dressage Competition
to be held on 15 April 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 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 the Southern Districts Dressage Club 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 Southern Districts Dressage Club
|
|
|
|
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
|
|
|
|