May 18 Partridge Acres Series

Rider First Name *

Rider Last Name *

Street Address *

Address Line 2

City *

State / Province *

Zip Code / Postal Code *

Phone Number *

Email Address *

Rider Date of Birth * +

Horse Name *

Owner Name *

Trainer Name *

Stable Name *

Rider OEF # *

Stepping Stone Sand Ring

Grand Prix Ring

Jumper Clear Rounds -- Enter number of clear rounds for each class below

	( 31 ) Cross Rails Clear Rounds $29.38
	( 33 ) 0.65m Clear Rounds $29.38
	( 35 ) 0.80m Clear Rounds $29.38
	( 37 ) 0.90m Clear Rounds $29.38
	( 39 ) 1.00m Clear Rounds $29.38
	( 41 ) 1.10m Clear Rounds $29.38
	( 43 ) 1.20m Clear Rounds $29.38

Jumper Classics

( 32 ) Cross Rails Jumper Classic $53.11

( 34 ) 0.65m Jumper Classic $53.11

( 36 ) 0.80m Jumper Classic $53.11

( 38 ) 0.90m Jumper Classic $53.11

( 40 ) 1.00m Jumper Classic $53.11

( 42 ) 1.10m Jumper Classic $53.11

( 44 ) 1.20m Jumper Classic $53.11

PA Medal

( 45 ) PA Medal $71.19

Derby Field

( 46 ) Open Derby Schooling Round $29.38

( 47 ) 2'3" Development Derby $53.11

( 47 ) 2'6" Development Derby $53.11

( 48 ) 2'3" Pony Derby $94.92

( 48 ) 2'6" Pony Derby $94.92

( 49 ) Mini Derby $94.92

( 50 ) Partridge Hunter Derby $124.30

*

Admin Fee $39.55

Current Total:

$0.00

By submitting this registration I confirm that I am over the age of eighteen (18). I also agree to be bound by the rules of the show and the facility.

I also agree to the following Waiver and Indemnification

I/WE THE RIDER, AND/OR THE PARENT OR LEGAL GUARDIAN THEREOF, IF MINOR, THE UNDERSIGNED:

UNDERSTAND AND ACCEPT THE ASSUMPTION OF INHERENT RISKS OF EQUESTRIAN ACTIVITIES AND SPORT ACTIVITIES IN GENERAL INCLUDING THE RISK OF SEVERE INJURY OR DEATH;

RELEASE AND INDEMNIFY PARTRIDGE ACRES, ITS STAFF, VOLUNTEERS AND ALL AFFILIATED ENTITIES AND PERSONS FROM ANY AND ALL INDEMNIFICATION & LIABILITY RESULTING FROM THESE RISKS AND ATTENDANCE AT PARTRIDGE ACRES;.

HAVE READ AND DO UNDERSTAND THIS RIDING INSTRUCTION/COMPETITION INDEMNIFICATION & LIABILITY RELEASE AGREEMENT, THE ASSUMPTION OF RISK, AND VOLUNTARILY SIGN THIS AGREEMENT, AND FURTHER AGREES THAT NO ORAL REPRESENTATION, STATEMENTS, OR INDUCEMENTS APART FROM THE ABOVE WRITTEN AGREEMENT HAVE BEEN MADE BY ANY OF THE RELEASED AND INDEMNIFIED PARTIES.

Name of Signatory (Rider or Parent/Guardian of Rider) : *

Signature of Rider or Parent/Guardian of Rider : *

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