Entry Form - Riverview Stables

Entry Form for OESS
June 07 & 28, 2015
(One form per rider/ horse combination)
RIVERVIEW STABLES
1445 Canaan Road, Cumberland Ontario, K4C 1G1
Tel. - 613 833-2317
Email address: [email protected]
Website: www.riverviewstables.com
(Entries Close Wednesday, May 27 & June 17 @ 6:00 pm)
Dressage Division Fee
(4 classes)
Hunter DIVISION FEE
(4 classes)
SHOW DATE
HORSE
$20
Group class
$15
Single Dressage Test
$25
Name of CLASS or Division
*** Test Of Choice***
indicate which test you will ride
$45
Single Hunter class o/f
RIDER
Class #
$75
Fee
Warm-up Hunter - $10.00
ENTRY FEES
OESS FEE
Office Administration Fee
$5 refunded to rider on show date if
nothing missing from entry
Late/Post Entry Fee
SCRATCH FEE
$20.00
$35.00
TOTAL
HST – 13%
GRAND TOTAL
$5.00
$10.00
Horse:________________________ Rider: ___________________________
AGREEMENT FOR ACCEPTANCE OF RISK & WAIVER OF LIABILITY
I understand that the sport of horses is a high risk sport & that I am participating at my own risk & in full
knowledge that there is some element of risk that an accident could occur & result in injury and / or death.
In consideration of acceptance of this entry or my being permitted to take part in the event, I agree to save
harmless & keep indemnified Riverview Stables Inc., show organizers, and their respective agents, officials,
servants & representatives from & against all claims, actions, cost and expenses and demands in respect of
death, injury, loss or damage to any person or property however caused, arising out of or in connection with
my taking part in this event & notwithstanding that the same may have been contributed to or occasioned by
negligence of Janet Borse & Craig McHugh, their agents, official, servants or representatives. It is understood
& agreed that the agreement is to be binding on myself, my heirs & assigns.
All competitors must wear proper fitting, approved protective headgear, with the safety harness correctly
secured, at all times while mounted. Approved headgear meets ASTM (American Society for Testing Materials)
standards & displays the SEI (Safety Equipment Institute) seal. It is hereby recognized that all equestrian
sports involve inherent risk & that no helmet or protective equipment can protect against all foreseeable
injury. I hereby accept this risk & hold harmless the competition, their officials, organizers, agents,
employees & representatives. By not wearing proper safety headgear, I fully accept all responsibilities of my
actions.
I hereby confirm that there is liability coverage in force with respect to the ownership of the competing
horse.
I acknowledge that I have read & fully understand & agree with the terms & conditions stated herein and that
it is binding upon my executors, heirs, and assigns.
Minors:
I acknowledge as Parent/Guardian of ______________________________ that I have read & fully understand
& agree with the terms & conditions stated herein on behalf of ____________________________ and myself.
Parent Signature: __________________________________________ BIRTHDATE _____________________
Stable Affiliation
Tel no.
Date
Signature
OEF#
Address
Postal code
Tel. Work
OWNER
Owner (print)
Home
 Owner
EMAIL Rider
Date
Signature
OEF#
Address
Postal code
Tel. Work
RIDER
Rider (print)
Home
“I/we hereby confirm that there is liability coverage in force with respect to the ownership of the competing
horse(s)” Signature ___________________________________ (attach photocopy of proof (OEF card))
√
Rider’s CHECKLIST
Check closing date for entries
Cheques payable to Riverview Stables
Photocopy of current year Coggins
OEF membership # Owner
OEF membership # Rider
Checked eligibility for divisions
“Acceptance of Risk” form – signed Coach
“Acceptance of Risk” form – signed owner
“Acceptance of Risk” form – signed rider
“Acceptance of Risk” form – signed
guardian
For Office Use - DO NOT WRITE IN THIS SPACE ↓
I hereby certify that this horse and rider combination is eligible as entered.
Coach Name (print):
Signature: