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S.D.D.C. & King
River Pony Club
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Dressage Competition
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& Training Day
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Sunday, 15 May 2022
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Entry Form
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Entries Close:
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Rider Details
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Rider Name
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Address
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Suburb/City
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PostCode
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Mobile Phone
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Email
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Rider Club Membership
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KRPC
Member/KRPC Open Rider
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Rider EA Number
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Rider PCWA Number
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Young Rider
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Parent/Guardian (if rider under
18yrs)
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Horse/Pony Details
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Horse Name
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Horse EA Number
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Horse Bridle Number
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Owner (if not Rider)
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Stallion
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Pony
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Emergency Contact
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Name
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Mobile Phone Number
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Helper Duties
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Helper Name
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First Preference
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Second Preference
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COMPETITION TESTS
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Competitor/Participant/ SDDC
& PCWA Restricted
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Classes: To enter please indicate 'X' alongside the particular test
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Sunday, 15 May 2022
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Preparatory A
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Preparatory C
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EA Preliminary 1B
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EA Preliminary 1C
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EA Novice 2B
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EA Novice 2C
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EA Elementary 3B
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EA Elementary 3C
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EA Medium 4B
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EA Medium 4C
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EA Advanced 5B
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EA Advanced 5C
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Para Tests
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Total
Tests
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Training Tests
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Classes: Please
indicate which tests you want to do
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Test Number 1
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Test Number 2
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Test Number 3
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Total Training Tests
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Fees
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Tests: Number of Tests
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Training: Number of Tests
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Entry Fees: (SDDC/KRPC Members - $25/test; Non-Members - $28/test))
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Training Tests: ($15/test)
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Ground Fees: (No Ground Fees for
KRPC Members or KRPC Open Riders; all other riders - $5/horse)
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Day Membership
Fee
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Late Entry Fee
($20)
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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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Southern Districts Dressage Club
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BSB
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036-168
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Account Number
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15-8842
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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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Reference
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Entrant Declaration
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I, the Entrant, agree to participate in the Southern Districts
Dressage Club's Dressage Competition on 15 May 2022
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I understand that by submission
of this entry form, I , the Entrant, state that I have read and
understand this Entrant Declaration, full particulars of which are available
on the S.D.D.C. website at:
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www.sddc.org.au/Waiver%20-%20Events%20-%2022%20Dec.pdf
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(including the risk
warning, indemnity, release and waiver) and agree to the terms and conditions
as stated.
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I understand the Southern Districts Dressage Club 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.
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Name
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Date
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My Emergency Contact for the activity
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and they can be contacted on:
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Third party indemnity where participant is under 18
years of age
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I,
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being the parent/guardian of the Entrant, hereby acknowledge
through the submission of this entry form:
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·
I have read the whole of this document and
understand it.
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I consent to the Entrant participating in the
Equestrian Activity.
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I am aware of the risks, dangers and obligations
set out in the E.A. Waiver of Events (2022) document.
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I acknowledge that the Entrant is bound by and
subject to the rules, regulations, guidelines, policies and codes of conduct
of EA and the Southern Districts Dressage Club.
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In consideration of the Entrant 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
Entrant and agree to personally accept all terms and conditions and
obligations set out in this declaration.
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AGREEMENT ON BEHALF OF ONE PARENT OR GUADIAN IS AGREEMENT ON
BEHALF OF ALL PARENTS AND/OR GUARDIANS OF THE ENTRANT.
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Parent/Guardian
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Date
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