Entry Form - Orange 
Coggins _______
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Rider: |
Youth DOB |
Horse Name |
Entry number |
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Address: |
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City
State Zip |
Rider
Phone: |
Trainer: |
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Phone: |
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Email: |
Email: |
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Division |
Classes (Circle ) |
$10/class
Pre-reg $12/Class
Day of $5
Leadline Class $10+ NYSHC
Class |
Owner (if
different):__________________________________ Address:__________________________________________ _________________________________________________ Phone:
___________________________________________ E-mail:____________________________________________ In
consideration of the acceptance of the foregoing entry, it is understood and
agreed that I/we are aware of the risks and exposures to personal injury
involved though horsemanship activities.
I/we hereby release Orange County Horse Council and Show Management
from all and every claim for damage which may accrue to me or the horse at any time hereafter in favor of
myself, my heirs, representatives or dependents, against said entity, owners,
or any matter, thing or conditions, negligence, or default whatever, and I/we
hereby assume and accept full risk and danger of any hurt, injury, or damage
which may occur through or reason of any matter, thing or conditions,
negligence or default, and/or any person or persons whatsoever, in the
exhibition sports, contest or any of them held or given by or under other
direction of said entity. Parent
or Guardian MUST sign entry of a Minor Participant. Rider
Signature:____________________________________(Date) Owner
Signature:____________________________________(Date) Parent/
Guardian Signature:____________________________________(Date) Make Checks Payable to Include copy of 2008 Coggins & Rabies Mail Entries to: Robin DeMaio Check #
________ Cash
________Initials_________ |
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English |
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Jumpers NYSHC* |
41 |
42 |
43 |
44* ($10+) |
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Walk-Trot
(English) |
14 |
15 |
16 |
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Beg.
Equitation |
17 |
18 |
19 |
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Short/Long
Stirrup |
20 |
21 |
22 |
23 |
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C/A
Equitation |
24 |
25 |
26 |
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Beg.
Hunter |
31 |
32 |
33 |
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Open
Equitation |
34 |
35 |
36 |
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Open
Hunter NYSHC* |
37 |
38 |
39* ($10+) |
40* ($10+) |
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Pleasure NYSHC* |
27 |
28 |
29 |
30* ($10+) |
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Western |
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Leadline
(Eng/West) |
Eng 10 |
Eng 11 |
Wes 12 |
Wes 13 |
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Walk/Jog |
48 |
52 |
56 |
61 |
67 |
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Novice |
47 |
51 |
55 |
60 |
66 |
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Junior |
46 |
50 |
54 |
59 |
65 |
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Open |
45 |
49 |
53 |
58 |
64 |
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Gymkhana |
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Junior |
1 |
4 |
6 |
8 |
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Senior |
2 |
5 |
7 |
9 |
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NYSHC
Barrels |
3 ($10+) |
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Cowboy
Versatility |
69 |
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Driving |
57 |
62 |
63 |
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Costume |
68 |
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Total Class Fees |
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Office Fee |
$5.00 |
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Stall Rental & Deposit |
$50.00 |
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Stall Deposit (Refundable after
stall is cleaned out) |
($25.00) |
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Total Due |
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