Detersmination Equestrian Center Show Entry Form
Use a separate sheet for each horse/exhibitor combination
Exhibitors Name: ___________________________________BACK #_______
Age: ____ Birthdate:________________________
Address:______________________________Phone # ________________ email:___________________
Horse’s Name
_____________________________________________
Registration type and #_________________________________________
Coggins
Test # _____________________________________________
Reminder: An ASTM approved helmet MUST be worn by all youth in All types of riding!
Class entry fee is $5 per class
with the exception of Halter Championship = no charge
I agree that I choose to participate voluntarily in this equestrian activity, and
by signing the entry blank, I agree and acknowledge that there is serious risk of harm including bodily harm, property damage
and even death. I assume all risks of harm to me, my horse, or my property. I agree
to release Detersmination Equestrian Center and their agents (officials, volunteers, owners, and affiliated organizations)
from all claims for money damages or otherwise for any harm to me or my horse and for any harm caused by me or my horse to
others, even if the harm is from negligence of Detersmination Equestrian Center.
Signature of Rider or parent if rider/handler is a minor (Mandatory)_________________________
Print name _____________________________
Please enter the class number you are registering for in boxes
provided
Number of
classes ______X $5 =______
Total________