ENTRY FORM

Rider:

Rider's Age:

Rider's Address:Rider's Email:

Rider's Phone:

Horse's Name:

Division/Tests:Coggins Date (proof attached):

EHV-1 Vaccination Date (proof attached):

Sire:

Dam:

Dam's Sire:

Please Indicate My Horse Is For Sale In The Program. Yes__________.

I would like my tests scheduled back to back. Yes ________________.

Please Schedule My Rides Close To: ____________________________.

I would like my horse videotaped. There is a 25.00 fee per test, due with your entry.

It will be mailed to your home within 10 days.Yes ________
Choose Tape ________, CD ________ DVD ________.

I/We acknowledge that equine activities, whether riding, working, or being around equines, are high risk activities. In consideration of the acceptance of this entry,I/We release and agree to hold harmless, Blue Waters Farm, Linda Santomenna,and Robert Alphin, from any and all claims and demands of every kind, whether I am mounted or not mounted. I have or may hereafter acquire, for any claim for bodilyinjury, death or property damage and from all liability for negligent acts or omissions.In addition, I specifically release Blue Waters Farm, Linda Santomenna, andRobert Alphin, from any and all claims for injuries to any part of my body,including death, whether the same may have been caused by the negligence of Blue Waters Farm, Linda Santomenna, and Robert Alphin. Blue Waters Farm, Linda Santomenna, and Robert Alphin have the right to refuse this entry for any reason which they deem sufficient.

Rider's Signature/Date:

Parent or Guardian of Minor Child/Date:

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