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  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