Bear Creek Buckaroos 4-H/FFA and Open Horse Show

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MISSOULA EQUESTRIAN PARK
2015 MEP Member?
OPEN Buckle Series
 Yes
 No
MEP Member ID:
ENTRY Form
# ___________
June 28, 2015
RIDER NAME: ____________________________________________________
RIDER AGE (if under 18): _______
ADDRESS: ______________________________________________________________________________________
Street
City
PHONE: ________________________________
ST
Zip
EMAIL: _______________________________________________
**ONE RIDER PER ENTRY FORM**
ENTRIES POSTMARKED BY JUNE 22 OR HAND-DELIVERED BY JUNE 26 TO AVOID POST-ENTRY FEE
MAIL/DELIVER ENTRY TO: CINDY ARNOTT, 1003 TOWER ST, MISSOULA, MT 59804
CLASS ENTRY ( from list on page 2)
LATE/POST ENTRY FEES
$6.00 per class
$2.00 per class
TOTAL NUMBER OF:
Classes: ____ x $6.00
Classes: ____ x $2.00
HIGH-POINT AWARD NOMINATIONS (select one or
more divisions)
 Novice/Maiden
 Youth
 Junior
 Senior
 Open
$5.00 per division
Divisions: ____ x $5.00
AMOUNT
Per Rider
$5.00 MEP Member
$10.00 Non-members
OFFICE FEE (waived if entering class #5 only)
Make checks payable to MISSOULA EQUESTRIAN PARK
TOTAL DUE

The signing of this entry form signifies the release of the Missoula Horsemen’s Council, the Missoula
Equestrian Park and Missoula County, as well as show management, officials and volunteers from any
liability or responsibility for any accident, injury, damage, or theft involving any horse, rider, equipment,
and/or other individual or property before, during and following this show; the acknowledgement that
participation is at your own risk; and the agreement to all rules and statements set forth for this show.
_______________________________
______________________________________
__________
Rider’s Name (print)
Rider’s Signature
Date
_______________________________
_______________________________________ __________
Parent/Guardian Name (print)
Parent/Guardian Signature (required if rider under 18)
Date
________________________________________________________________________
__________
Parent/Guardian Street Address
Phone
City
ST
***OFFICE USE ONLY***
COMP #
MEP #
WAIVERS
SIGNATURES
AMT PD
CHECK #
Zip
Questions? Contact Cindy @ 544-5915
or email to [email protected]
2015-05-30
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MISSOULA EQUESTRIAN PARK
Open Buckle show CLASS ENTRY
Check each class to enter and fill in the name of the horse entrant will be riding in that class.

#
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
CLASS
Novice/Maiden Showmanship
Youth Showmanship
Junior Showmanship
Senior Showmanship
Open Showmanship
Leadline, 9 & under
Novice/ Maiden Western Pleasure Walk/Trot
Open Western Pleasure Walk/Trot
HORSE
`
Youth Western Pleasure
Junior Western Pleasure
Senior Western Pleasure
Open Western Pleasure
Novice/Maiden Horsemanship
Youth Horsemanship
Junior Horsemanship
Senior Horsemanship
Open Horsemanship
Novice/Maiden Trail
Youth Trail
In-Hand Trail
Junior Trail
Senior Trail
Open Trail
Novice/Maiden & Youth English Pleasure Walk-Trot
Open English Pleasure Walk/Trot
Junior English Pleasure
Senior English Pleasure
Open English Pleasure
Novice/Maiden & Youth English Equitation
Junior English Equitation
Senior English Equitation
Open English Equitation
Open Barrels
Barrels, 14 & Under
Open Poles
Poles, 14 & Under
Open Keyhole
Keyhole, 14 & Under
____ Total Number of Classes Entered
HIGH POINT CLASSES: Novice/Maiden Horse or Rider (1, 7, 13, 18, 24, 29); Youth (2, 9, 14, 19, 24, 29); Junior (3,
10, 15, 21, 26, 30); Senior (4, 11, 16, 22, 27, 31); Open (5, 8, 12, 17, 23, 25, 28, 32)
2015-05-30
Page 3 of 3
MISSOULA EQUESTRIAN PARK
Open Buckle show Waivers
Please complete and sign the following two waivers, as necessary.
Assumption of Risk Agreement for All Non-Members of the Missoula Equestrian Park
If you are not a current member of the Missoula Equestrian Park, you must complete the Missoula Horsemen’s Council
Membership & Assumption of Risk Agreement located on the MEP website at:
http://missoulaequestrianpark.org/pdf/MEPMembershipForm2015.pdf
INSTRUCTIONS for completion of this waiver:
•
To sign the waiver without purchasing a membership, complete all information on the left side of the form and
sign where indicated. On the right side of the form under SINGLE DAY GUEST PASS FEES, write in “Open Show.” No
additional fee is associated with signing of this waiver.
MEP MEMBERSHIP SHOW SPECIAL – The Show Office Fee will be omitted for joining members!
•
If you want to join the Missoula Equestrian Park in conjunction with entering this show, complete all information
on the left side of the form and sign where indicated. On the right side of the form, complete the appropriate
membership information and under SINGLE DAY GUEST PASS FEES, write in “Open Show.” Please include a separate
check for your membership fee. Then, in the OFFICE FEE box on the Entry Form above write in “New Member” and
omit the $10.00 office fee for this show.
Recommendation and Waiver of Use of ASTM/SEI Approved Protective Headgear
Missoula Horseman’s Council, dba Missoula Equestrian Park, recommends the use of a properly fitting ASTM/SEI approved
equestrian helmet for all individuals participating in horseback riding activities.
Minor children are REQUIRED to wear helmets while horseback in the Missoula Equestrian Park at all times, unless a waiver
has been signed by a legal guardian for an approved event.
Protective helmets are REQUIRED for any event, practice, training or activity over fences (jumping) anywhere in the
Missoula Equestrian Park.
If you choose to ride without helmet or substitute another helmet for the ASTM/SEI approved equestrian helmet you must
sign this release form below.
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------I understand the additional safety an ASTM/SEI approved equestrian riding helmet provides. I understand that riding
without an appropriate helmet increases the risk of injury in the event of an accident. I choose for myself to ride without
an ASTM/SEI approved riding helmet and I assume full responsibility for this decision.
I have read, understand and agree to be bound by the stipulations stated in the warning.
SIGNATURE of PARTICIPANT or PARENT/GUARDIAN
_________________________________
________
_________________________________
Rider’s Name (print)
Rider’s Age (if under 18)
Parent/Guardian Name if under 18 (print)
_________________________________________________
____________
Rider Signature or Parent/Guardian Signature (if under age 18)
Date
__________________________________________________________________
_______________
Street Address
Phone
City
St
Zip
2015-05-30