Office Use Only
Office Use Only
Only ONE HORSE per entry form. PLEASE type or print clearly.
Federation Entry Agreement I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR906.4) as printed in the Prize List for [Menlo Charity Horse Show] (“Competition”) and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, the Prize List, and local rules of the competition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against the Federation must be brought in New York State. Release, Assumption of Risk, Waiver and Indemnification - This document waives important legal rights. Read it carefully before signing. I AGREE in consideration for my participation in this Competition to the following: Menlo Charity Horse Show I AGREE that the “Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”). I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or the Competition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and, if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf I represent that I have the requisite training, coaching and abilities to safely compete in this competition. I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form. BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank and all terms and provisions of this Prize List. If I am signing and submitting this Agreement electronically, I acknowledge that my electronic signature shall have the same validity, force and effect as if I affixed my signature by my own hand.
I hereby ceritfy horse and rider are eligbile as entered.. "The undersigned (herein described as Entrant) understands and acknowledges that horse sports and the competition involve inherent dangers that include, but are not limited to, hazards of personal injury, property damage or wrongful death. ENTRANT HEREBY EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISK OF INJURY OR LOSS as a result of participation in the Horse Show. In consideration of the admission and entry of Entrant, and any other participants in said Show, ENTRANT HEREBY WAIVES, RELEASES, INDEMNIFIEDS, AND HOLDS HARMLESS the following from and against any and all claims, demands, expenses, losses and/or causes of action which Entrant, rider, or any other participant to said Horse Show might otherwise now or hereafter have against the Menlo Charity Horse Show, the Menlo Circus Club, the Vista Center for the Blind and Visually Impaired, the USEF, the USHJA, the PCHA and the NORCAL, it's officers, members, agents, employees, licensees and invitees and any person, firm, corporation, and the entity or any one or more of them connected in any way with said Horse Show, or in control of the premises or equipment related thereto and each of them, for damage to property and/or injury or death to person, including the Entrant, arising out of, or in any way connected with participation in said Horse Show, INCLUDING, BUT NOT LMITED TO PERSONAL INJURY OR INJURIES, PROPERTY DAMAGE OR WRONGFUL DEATH CUASED BY NEGLIGENCE. It is understood and agreed that this waiver, release and assumption of risks is to be binding upon Entrant's heirs and assigns. The Entrant acknowledges that he or she has read the foregoing and is fully aware of the legal consequences of signing below." The owner agrees to INDEMNIFY AND HOLD the Menlo Charity Horse Show, the Menlo Circus Club, the Vista Center for the Blind and Visually Impaired, the USEF, the USHJA, the PCHA, and the NORCAL Hunter Jumper Association their officials, directors, employees and agents HARMLESS FROM AND AGAINST ALL CLAIMS including any claims for injury or loss suffered by me or anyone else in connections with the competition, WHETHER OR NOT SUCH CLAIM, INJURY OR LOSS RESULTS, DIRECTLY OR INDIRECTLY, FROM MY NEGLIGENCE OR OMISSIONS OR THE NEGLIGENT ACTS OR OMISSIONS OF SAID OFFICIALS, DIRECTORS, EMPLYEES OR AGENTS OF THE USEF OR COMPETITION. For example, if my horse injures someone or someone's property, I agree and indemnify and hold the aforementioned parties harmless from all claims for injury or loss. If the trainer is signing below on behalf of the owner, the trainer is hereby representing thta he or she is duly authorized to sign on behalf of the owner.
Entry Fees = Processing fee $125.00 (required w/entry) =$ 125.00 Stall Fee @ $300.00 = Late Fee postmarked after July 10 $50.00=
Jumper Nomination @ $150.00 = Non Stalled Horse $100.00/day = Facility Fee (per stalled horse) $30.00 =$ 30.00 USEF Federation Fee @$16.00 $ 16.00 (USEF $8; D/M $8) = USHJA Fee $7.00 =$ 7.00 Town of Atherton Usage Fee $6.00 =$ 6.00 PCHA Fee $3.00; NCHJA Fee $3.00; $ 11.00 COFA Fee $5.00 = USEF NM Show Pass Fee: ($30) USHJA NM Show Pass Fee: $30 Total Due = Amount Enclosed - MUST ENCLOSE STALL & PROCESSING FEES Stalls will not be reserved without payment!
Alternate Payee - if different than owner
Coach Parent/Guardian Emergency Contact
Failure to present proper USEF/USHJA membership cards will result in non-member fees being charged.
Menlo Charity accepts all major credit cards - PLEASE USE CREDIT CARD FORM
Pacific Coast Horse Shows Association
NORCAL HUNTER JUMPER ASSOCIATION P.O. Box 7090 Cotati, CA 94931
P.O. Box 5570, Glendale, CA 91221
(707) 794-8938
(818) 842-8194
NEW
MEMBERSHIP APPLICATION
MEMBERSHIP APPLICATION
ANNUAL LIFE
$40 $400
TRANSFER OF OWNERSHIP
FAX # (818) 842-6048
RENEWAL
HORSE
ANNUAL LIFETIME
$25 $75
$5
NAME CHANGE
$5
NEW Senior: $75.00
RENEWAL
Junior: $55.00
SPECIAL: Senior: $200.00 for 3 years
Life: $1,000.00
SPECIAL: Junior: $150.00 for 3 years “No increase if a junior becomes a senior during 3 year plan
STEWARD
MANAGER
SHOW CONTACT
Name:
______________________________________________________________
Address:
______________________________________________________________
NAME __________________________________________________________
City:
_____________________________ State: _____ Zip: ______________
ADDRESS
E-Mail:
______________________________________________________________
CITY/STATE
_______________________________ ZIP ________________
Telephone:
____________________
TELEPHONE
____________________________________________________
DOB: (Required)
________________
Cell Phone: _____________________________ Trainer: ________________________________ Check size if Pony
* Horse(s):
_______________________________________________
_______________________________________________
Sm
Med
Lge
DATE OF BIRTH REQUIRED
JUNIOR
AMATEUR
HORSE REGISTRATION Horse must be registered to compete for Yearend Awards SHOW NAME OF HORSE
I do not need a Rule Book and can access it online I would like to receive a copy of the NorCal Rule Book ($10) RENEWAL: I do not need a paper renewal form in 2016. I will renew online I do not want NorCal to release my email address
_________________________________________
Hunter / Jumper
PROFESSIONAL
RULE BOOK:
______________________________________
Hunter / Jumper Western Amateur Professional
_______________________________________________ For Transfers, Please list former owner’s name * Horse registration must be paid before points can accrue.
_______________________________________________________
Western
Color ______ Sex ___ Ht. _________ Yr. Foaled _______ Breed _______ OWNER OF HORSE
______________________________________________
(MUST BE A MEMBER) OWNER PCHA # _______________________________
YEARLY REGISTRATION $40.00 LIFETIME REGISTRATION $100.00 SHOW NAME CHANGE $10.00 FORMER NAME TRANSFER OF OWNERSHIP $10.00 FORMER OWNER
Only ONE HORSE per entry form. PLEASE type or print clearly.
Federation Entry Agreement I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR906.4) as printed in the Prize List for [Menlo Charity Horse Show] (“Competition”) and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, the Prize List, and local rules of the competition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against the Federation must be brought in New York State. Release, Assumption of Risk, Waiver and Indemnification - This document waives important legal rights. Read it carefully before signing. I AGREE in consideration for my participation in this Competition to the following: Menlo Charity Horse Show I AGREE that the “Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”). I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or the Competition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and, if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf I represent that I have the requisite training, coaching and abilities to safely compete in this competition. I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form. BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank and all terms and provisions of this Prize List. If I am signing and submitting this Agreement electronically, I acknowledge that my electronic signature shall have the same validity, force and effect as if I affixed my signature by my own hand.
I hereby ceritfy horse and rider are eligbile as entered.. "The undersigned (herein described as Entrant) understands and acknowledges that horse sports and the competition involve inherent dangers that include, but are not limited to, hazards of personal injury, property damage or wrongful death. ENTRANT HEREBY EXPRESSLY AND VOLUNTARILY ASSUMES ALL RISK OF INJURY OR LOSS as a result of participation in the Horse Show. In consideration of the admission and entry of Entrant, and any other participants in said Show, ENTRANT HEREBY WAIVES, RELEASES, INDEMNIFIEDS, AND HOLDS HARMLESS the following from and against any and all claims, demands, expenses, losses and/or causes of action which Entrant, rider, or any other participant to said Horse Show might otherwise now or hereafter have against the Menlo Charity Horse Show, the Menlo Circus Club, the Vista Center for the Blind and Visually Impaired, the USEF, the USHJA, the PCHA and the NORCAL, it's officers, members, agents, employees, licensees and invitees and any person, firm, corporation, and the entity or any one or more of them connected in any way with said Horse Show, or in control of the premises or equipment related thereto and each of them, for damage to property and/or injury or death to person, including the Entrant, arising out of, or in any way connected with participation in said Horse Show, INCLUDING, BUT NOT LMITED TO PERSONAL INJURY OR INJURIES, PROPERTY DAMAGE OR WRONGFUL DEATH CUASED BY NEGLIGENCE. It is understood and agreed that this waiver, release and assumption of risks is to be binding upon Entrant's heirs and assigns. The Entrant acknowledges that he or she has read the foregoing and is fully aware of the legal consequences of signing below." The owner agrees to INDEMNIFY AND HOLD the Menlo Charity Horse Show, the Menlo Circus Club, the Vista Center for the Blind and Visually Impaired, the USEF, the USHJA, the PCHA, and the NORCAL Hunter Jumper Association their officials, directors, employees and agents HARMLESS FROM AND AGAINST ALL CLAIMS including any claims for injury or loss suffered by me or anyone else in connections with the competition, WHETHER OR NOT SUCH CLAIM, INJURY OR LOSS RESULTS, DIRECTLY OR INDIRECTLY, FROM MY NEGLIGENCE OR OMISSIONS OR THE NEGLIGENT ACTS OR OMISSIONS OF SAID OFFICIALS, DIRECTORS, EMPLYEES OR AGENTS OF THE USEF OR COMPETITION. For example, if my horse injures someone or someone's property, I agree and indemnify and hold the aforementioned parties harmless from all claims for injury or loss. If the trainer is signing below on behalf of the owner, the trainer is hereby representing thta he or she is duly authorized to sign on behalf of the owner.
Entry Fees = Processing fee $125.00 (required w/entry) =$ 125.00 Stall Fee @ $300.00 = Late Fee postmarked after July 10 $50.00=
Jumper Nomination @ $150.00 = Non Stalled Horse $100.00/day = Facility Fee (per stalled horse) $30.00 =$ 30.00 USEF Federation Fee @$16.00 $ 16.00 (USEF $8; D/M $8) = USHJA Fee $7.00 =$ 7.00 Town of Atherton Usage Fee $6.00 =$ 6.00 PCHA Fee $3.00; NCHJA Fee $3.00; $ 11.00 COFA Fee $5.00 = USEF NM Show Pass Fee: ($30) USHJA NM Show Pass Fee: $30 Total Due = Amount Enclosed - MUST ENCLOSE STALL & PROCESSING FEES Stalls will not be reserved without payment!
Alternate Payee - if different than owner
Coach Parent/Guardian Emergency Contact
Failure to present proper USEF/USHJA membership cards will result in non-member fees being charged.
Menlo Charity accepts all major credit cards - PLEASE USE CREDIT CARD FORM
Pacific Coast Horse Shows Association
NORCAL HUNTER JUMPER ASSOCIATION P.O. Box 7090 Cotati, CA 94931
P.O. Box 5570, Glendale, CA 91221
(707) 794-8938
(818) 842-8194
NEW
MEMBERSHIP APPLICATION
MEMBERSHIP APPLICATION
ANNUAL LIFE
$40 $400
TRANSFER OF OWNERSHIP
FAX # (818) 842-6048
RENEWAL
HORSE
ANNUAL LIFETIME
$25 $75
$5
NAME CHANGE
$5
NEW Senior: $75.00
RENEWAL
Junior: $55.00
SPECIAL: Senior: $200.00 for 3 years
Life: $1,000.00
SPECIAL: Junior: $150.00 for 3 years “No increase if a junior becomes a senior during 3 year plan
STEWARD
MANAGER
SHOW CONTACT
Name:
______________________________________________________________
Address:
______________________________________________________________
NAME __________________________________________________________
City:
_____________________________ State: _____ Zip: ______________
ADDRESS
E-Mail:
______________________________________________________________
CITY/STATE
_______________________________ ZIP ________________
Telephone:
____________________
TELEPHONE
____________________________________________________
DOB: (Required)
________________
Cell Phone: _____________________________ Trainer: ________________________________ Check size if Pony
* Horse(s):
_______________________________________________
_______________________________________________
Sm
Med
Lge
DATE OF BIRTH REQUIRED
JUNIOR
AMATEUR
HORSE REGISTRATION Horse must be registered to compete for Yearend Awards SHOW NAME OF HORSE
I do not need a Rule Book and can access it online I would like to receive a copy of the NorCal Rule Book ($10) RENEWAL: I do not need a paper renewal form in 2016. I will renew online I do not want NorCal to release my email address
_________________________________________
Hunter / Jumper
PROFESSIONAL
RULE BOOK:
______________________________________
Hunter / Jumper Western Amateur Professional
_______________________________________________ For Transfers, Please list former owner’s name * Horse registration must be paid before points can accrue.
_______________________________________________________
Western
Color ______ Sex ___ Ht. _________ Yr. Foaled _______ Breed _______ OWNER OF HORSE
______________________________________________
(MUST BE A MEMBER) OWNER PCHA # _______________________________
YEARLY REGISTRATION $40.00 LIFETIME REGISTRATION $100.00 SHOW NAME CHANGE $10.00 FORMER NAME TRANSFER OF OWNERSHIP $10.00 FORMER OWNER
