Arabian Horse Association Region 10 Off-site Working Western Championships

held in conjunction with the First Annual North Central Working Western Horse Celebration

Saturday, June 22, 2013Jim Simon Arena

Cannon Falls, Minnesota

Send Entries To:Gary Paine, AHA Show Secretary

17525 G76 Hwy Laconia, IA 50139glpaine@yahoo.com

Judge: Tim Stewart

Paso Robles, California

For More Information:Sandra Woerle, Show Manager

woerle79@aim.com

Arabian Horse Association Show Recognition Competition Sponsor:

AHA Recognition Show/Recording Number:

Join AHA through your local club for the following great member benefits:

Discounted subscription to • Modern Arabian Horse magazine

Reduced rate for competition privileges across •a variety of disciplines for local, regional and national AHA-approved shows and rides

Peace of mind with 1 million in personal •liability insurance through Equisure

Preferred rates on horse registrations and •transfers

Preferred rates on ArabDataSource, the world’s largest online Arabian horse resource•

No annual fee, low interest rate Bank of America affinity credit card•

Numerous opportunities to participate in award recognition and prize money programs•

Show circuits for AHA members at local, regional and national levels •

Contact your local club:

The Arabian Horse Association is a major equine

association serving members in the United

States and Canada. It registers and maintains

a database of more than one million Arabian,

Half-Arabian and Anglo-Arabian horses and

administers more than $2.5 million in annual

prize money. AHA produces championship

events, recognizes over 500 Arabian horse

shows and distance rides annually and provides

activities and programs that promote breeding

and ownership. For information about Arabian,

Half-Arabian and Anglo-Arabian horses, call

303-696-4500, e-mail info@ArabianHorses.org

or visit ArabianHorses.org.

Arabian Horse Association 10805 East Bethany Drive Aurora, CO 80014 303.696.4500 303.696.4599 fax ArabianHorses.orgAHA 090032 (Rev. 12/09)

The Judges & Stewards Commissioner is responsible for handling written and signed complaints relating to judges’ and stewards’ conduct when filed by exhibitors, show officials, AHA members or others, and when accompanied by a ten-dollar ($10.00) filing fee [Resolution 5-90]. Other comments, compliments, questions, inquiries are encouraged when appropriate (no filing fee required). Write: Judges & Stewards Commissioner, PO Box 440949, Aurora, CO 80044-0949; (303) 696-4537.

Region XI Championship Show

131111819 Pre Show A 131111820 Pre Show B 131111821 Regional Show

Region 10 Working Western Off-Site Championships

131011917

Arabian Horse Association Region 10 Off-site Working Western Championships

Class Listing

Class # Class Code Class Name

001

263 AHA Region 10 Purebred Reined Cow Horse Open Championship

002

707

AHA Region 10 Half-Arabian/Anglo-Arabian Reined Cow Horse Open Championship

003

264

AHA Region 10 Purebred Reined Cow Horse ATR Championship

004

708

AHA Region 10 Half-Arabian/Anglo-Arabian Reined Cow Horse ATR Championship

005

1134

AHA Region 10 Purebred Limited Reined Cow Horse ATR Championship

006

1141

AHA Region 10 Half-Arabian/Anglo-Arabian Limited Reined Cow Horse ATR Championship

007

250

AHA Region 10 Purebred Working Cow Horse Open Championship

008

685

AHA Region 10 Half-Arabian/Anglo-Arabian Working Cow Horse Open Championship

009

255

AHA Region 10 Purebred Working Cow Horse ATR Championship

010

689

AHA Region 10 Half-Arabian/Anglo-Arabian Working Cow Horse ATR Championship

011

258

AHA Region 10 Purebred Working Cow Horse Jr. Horse Championship

012

701

AHA Region 10 Half-Arabian/Anglo-Arabian Working Cow Horse Jr. Horse Championship

Class Fees

Championship Class Entry Fee……………………………………………………….$50 Championship Class Cattle Fee………………………………………………………$50 USEF Fees………………………………………………………………………………$16 AHA 9-90/Educational………………………………………………………………….$18 Office Fee……………………………………………………………….……………….$10

Neck Garland/Trophy/Ribbon to Champion & Reserve. Ribbon/Award to full Top 5

Please use stabling request form for stall reservations and bedding orders.

REGION 10 GENERAL RULES & REGULATIONS

1. Life, Senior Active and Junior Active members shall be eligible to participate in all classes at Regular Competitions, Eventing Competitions at the Preliminary Level or above and Combined Driving Competitions at the Advanced Level, Dressage, Reining and Vaulting Competitions and Endurance Rides. A nonmember may participate as a handler, rider, driver, owner, lessee, agent, coach or trainer at Regular Competitions, Eventing Competitions, Dressage Competitions, Reining Competitions and Combined Driving Competitions upon payment of a $30 non-member registration fee. Participants in the following classes are exempted from the requirements of this rule; 1) leadline; 2) exhibitions; 3) games and races; 4) classes for 4-H members; 5) walk trot and academy classes (academy classes are classes limited to horses used regularly in a lesson program); 6) USDF introductory level tests, pas de deux and quadrille classes; 7) NRHA Endorsed Reining Competitions; 8) Opportunity classes; 9) citizens of other nations who have proof, in English, of current membership in good standing of their own National Federation; 10) USEA beginner Novice Division; and 11) Assistant Handlers in Dressage Sport Horse Breeding classes. 2. USEF RULES. Every class offered herein which is covered by the rules & specifications of the current USEF Rule Book, will be conducted & judged in accordance therewith. See USEF Rule Book for Arabian rules, class description & judging specs. Any changes in the USEF rules will automatically become a part of this Prize List. Show Committee reserves the right to make such changes in procedure, personnel, rules & regulations as deemed by them to be in the best interest of the show. 3. ADMISSION TO ARENA. No person will be permitted to enter the arena except the judges, their assistants, the exhibitors in the class and the show photographer. Headers will not be permitted in the arena until summoned by order of the Judge. 4. AFFIDAVITS. USEF will NOT accept membership affidavits. If an exhibitor does not submit the proper membership documentation to the competition and the competition cannot verify such information the exhibitor will be responsible to pay a $30 USEF non-member fee and a $30 non-member amateur fee (if applicable) which are non-refundable. AHA will not accept membership affidavits. Current AHA Competition membership cards or a copy must be presented at the show office, or included with entries. 5. AMATEUR OWNER QUALIFICATIONS. All horses entering any Regional Amateur Owner (AO, AAO, JO) Championship class must have been qualified by an Amateur Owner. It is the responsibility of the Amateur Owner to abide by this rule. (AHA Article 1423). For Amateur Owner definitions see USEF/EC Rules. 6. ARRIVAL AND DEPARTURE TIME. Stalls will be available Tuesday, June 18, 2013. If earlier arrival is desired, please contact the Barn Manager to make specific arrangements (additional charge of $20 per horse stall per day will be charged). Barn Manager will post stall assignment chart in barn office showing stall and aisle numbers. Do not stall a horse unless stall has been assigned. Stalls must be vacated by noon Monday, June 24th or additional $50 per horse stall per day will be charged.

7. CALLS FOR CLASSES. Classes will be called promptly. The two minute rule will be STRICTLY ENFORCED. Tack changes must be reported to the Paddock Manager at least two classes ahead to permit proper notification to ring officials. All tack changes must be made in paddock area 8. CAMPERS. Campers are allowed in the designated camping area and are subject to a daily camping fee. 9. AWARDS. Top Five awards will be made regardless of the number of entries in the class. Champion and Reserve Champion will be named from the Top Five. However, only awards made to the top 50% of the class (rounded up and not to exceed 5 awards) will receive AHA Horse Achievement Awards, Amateur Achievement Awards, High Point Amateur Achievement Award and Distance Award Points. (Article 1220, paragraph 1.b) 10. CRUELTY. Cruelty to or the abuse of a horse by any person at a recognized show is forbidden. Excessive use of a whip on any horse in a stall, runway, schooling area, show ring, or elsewhere on the show grounds, before or during a show, by any person, constitutes a violation and renders the offender subject to penalty. 11. DISPUTES. Disputes, if any, over Regional Championship Classes that cannot be settled by the local Show Committee shall first be referred to the Working Western Horse Celebration Show Committee. Disputes that cannot be resolved by the Committee shall be referred to the AHA National and Regional Classes Committee. 12. DOGS/ANIMALS. All dogs/animals must be confined to a leash/cage at all times. 13. ELIGIBILITY. To be eligible, a horse or rider must qualify in accordance with Regional Show Rules as set forth in the current AHA Handbook. It is the responsibility of the person(s) signing the entry form to verify that the horse and/or rider being entered and completing is eligible to be entered and to enter the horse and/or rider in the correct classes. 14. ENTRIES: There is no post-entry fee. Entries are taken until the close of the gate two classes prior to the desired class. Post entries will be added to the top of the posted draw order, except in cutting and herd work in which case they are added to the bottom of the posted draw order. It is recommended that entries be sent prior to June 1, 2013, in order to be included in show program. Entries must be accompanied by photo copies and full payment in order to be processed. Entries must be signed by the owner/agent, trainer and ALL riders/drivers/handlers/coaches. Juniors may not sign entry forms. Exhibitors are responsible for their own errors. 15. HEALTH REQUIREMENTS. The State of Minnesota requires a negative Coggins test on all horse and 30 day health papers on all out of state horses. 16. FOOD. Concession stands will be open during the competition. 17. INDEMNITY & NON-RESPONSIBILITY CLAUSE. The NCRCHA, Region X and the Jim Simon Arena will not be responsible for any loss, personal injury or damage to horses exhibited or for any kind of nature that may be lost or destroyed or in any way damaged.

18. JUDGES. In the event of illness or failure of a Judge to attend this show or to perform their duties, Show Committee reserves the right to substitute a Judge. 19. JUNIOR EXHIBITORS. One who has not, as of December 1st, reached his/her 19th birthday. 20. ‘NO SHOWS’. To help expedite the show, please report all scratches to the show office. No Shows will be assessed a $50 fee per class. 21. NON-MEMBER FEES. Any owner/trainer/rider/driver/handler exhibiting at a Regional Show MUST be a current AHA Competition member. Single Event memberships do not apply at Regional Shows. Any owner/trainer/rider/driver/handler must be a member of USEF or pay a $30 non-member fee. Copies of AHA and USEF membership cards for each owner/trainer/rider driver/handler must be submitted with entries, or those entries will be considered incomplete and subject to post entry fees. 22. P.A. SYSTEM. Due to possible unforeseen problems with any mechanical device, the P.A. system & class calls over that system are considered a courtesy. It is the exhibitor’s responsibility to have his/her horse at the gate at the prescribed time. While every effort will be made to maintain a working P.A. system, no protest will be upheld nor will any section be changed on basis of P.A. breakdown. 23. PROTESTS. Any protest must be made in accordance with USEF rules governing protests. 24. QUALIFICATIONS. See current AHA Handbook regarding Regional qualifications. 25. REGISTRATION REQUIREMENTS. Horses to be shown in classes designated for Purebred Arabians must be registered with the Arabian Horse Association or the Canadian Arabian Horse Registry. Horses to be shown in classes designated for Half-Arabians/Anglo-Arabians must be registered with the Half-Arabian Registry of the AHA. Copies of registration papers for each horse must accompany entries or entries will be considered incomplete and charged post entry fees. Only horses with permanent registration numbers will be recorded. Horses shown with a pending registration number and their rider, driver, handler will not be recorded. (BOD 1/ 02) 26. RETURNED CHECKS, REFUSED CREDIT CARD PAYMENTS. There is a $35 charge for all checks or charges returned by bank for any reason. Interest of 1 1/2% per month will be assessed on all outstanding accounts. Refused checks or charges not paid within 2 weeks after notification will be turned over to AHA & USEF. REFUSED CHECKS OR CHARGES NOT PAID WITHIN 30 DAYS WILL BE ASSESSED A $100.00 CHARGE. 27. SHOW OFFICE HOURS. Tuesday, June 18th 3:00 pm to 7:00 pm Wednesday, June 19th 9:00 am to noon and 1:30 pm to 7:00pm Thursday, June 20th 7:00 am to 1/2 hour after show Friday, June 21st 7:00 am. to 1/2 hour after show Saturday, June 22nd 7:0 am to 1/2 hour after show Sunday, June 23rd 7:00 am to 1 hour after show

28. SMOKING. Smoking is NOT permitted in the arena or barn areas. 29. STALLS. Stalls are box stalls with doors. If number of entries exceeds permanent stabling, portable stalls will be used. The Show Committee reserves the right to limit tack stalls without notification prior to arrival. Telephone stall requests are not guaranteed. Location and quantity of stalls requested are not guaranteed until payment is received. 30. VEHICLES. Vehicles of any kind will not be allowed in barns, on sidewalks, in arenas, paddocks or schooling areas, and drivers must be 16 years or older. Vehicles parked in designated no parking areas are subject to towing. 31. WITHDRAWAL OF ENTRIES. Horses entered must be shown unless excused by the management in writing. All fees for entries canceled before the June 1st deadline will be refunded, less Office Charges. Refunds for class entry fees only will be made upon presentation to the Show Secretary of a signed and dated Veterinarian’s Certificate on or before the end of the last class of the show. 32. GATE AREA. In case of accident or emergency inside the arena the gate area must be cleared immediately and kept clear for emergency personnel and vehicles. 33. Motorized Vehicles: Minors who do not have a valid driver’s license which allows them to operate a motorized vehicle in the state in which they reside will not be permitted to operate a motorized vehicle of any kind including, but not limited to, golf carts, motorcycles, scooters, or farm utility vehicles on the competition grounds of licensed competitions. Minors who have a valid temporary license may operate the above described motorized vehicles as long as they are accompanied by an adult with a valid driver’s license. Violations of this rule will be cause for sanctions against the parent(s), guardian(s) and/or trainer(s) who are responsible for the child committing the offense. Penalties may include exclusion of the child, parent(s), guardian(s), and/or trainer(s) from the competition grounds for the remainder of the competition and charges being filed against any of the above individuals in accordance with Rule 6. Wheelchairs and other mobility assistance devices for individuals with disabilities are exempt from this rule. A block of rooms have been reserved at the

Best Western Hotel in Cannon Falls, MN

Space is limited so make your reservations early

Best Western Saratoga Inn

31591 64th Avenue

Cannon Falls, MN 55009 For reservations call:

(507) 263-7272 (800) 528-1234

bwsaratogo@gmail.com

www.bestwesterm.com/saratogain

PLEASE TYPE OR PRINT/ONLY ONE OWNER PER ENTRY FORM. All entries must be complete. Enclose correct fees, copies of horse registration papers, purchase contract (if applicable), USEF/EC membership cards, amateur certification, and AHA membership cards for each rider, driver, handler, and owner. Name of F irst Horse

Reg. No.

DOB

Sex

Color

Height

Sweepstakes Yes No

Sire Dam USEF Horse ID # Entry Fees

Rider #1 AHA # Class Numbers

USEF/EC # $

Rider #2 AHA # Class Numbers

USEF/CEF # $

FOR MORE THAN TWO RIDERS WITH SAME HORSE, USE NEXT TABLE, LEAVING HORSE DATA BLANK Name of Second Horse Reg. No. DOB Sex Color Height Sweepstakes

Yes No

Sire Dam USEF Horse ID # Entry Fees

Rider #1 AHA # Class Numbers

USEF/CEF # $

Rider #2 AHA # Class Numbers

USEF/CEF # $

SEND TO: Gary Paine 17525 G 76 Hwy

Lacona, IA 50139 Phone: 641-466-3320

REGION 10 WORKING WESTERN CHAMPIONSHIPS June 22, 2013 Show Sect’y contact information

Email: glpaine@yahoo.com

Each person signing this entry form acknowledges that he/she has read the front and reverse side of this entry form and agrees to the applicable terms, conditions, waivers and consent as set forth herein. Each person agrees that the information is accurate to the best of his/her knowledge. All OWNERS, RIDERS, DRIVERS & HANDLERS MUST SIGN ON THE BACK. Minor entrants must also have parent/guardian signature(s) on the back

_______

TOTAL CLASS FEES $50 per class

$_________

_______ AHA Membership Fee $ _________

OWNER (as appears on reg. papers or contract)

_______

USEF Fee @ $16 per horse ($8 Drug; $8 Administration)

$_________

Name__________________________________________________________ AHA #________________________ _______ $18 (Mandatory per horse)

Resolution 9-90+Recocnition

$_________

Address________________________________________________________ USEF / EC #___________________ _______ Office Fee:$10 Per Horse

$_________

City, State, Zip___________________________________________________ Phone________________________ _______ USEF Non-Member Fee $30 $_________

_______ USEF Non-Member Amateur $30

$_________

e-mail_________________________________________________________ _______

Patron Sponsor $500

$_________

Class Sponsorship $50 $ _________ TRAINER_______________________________________________________ Address________________________________________________________ USEF / EC #___________________ _______ Cattle Fee $50/class $ ________ City, State, Zip___________________________________________________

Phone________________________

ENCLOSED TOTAL FEES

$_________

e-mail__________________________________________________________

Send stabling request form to: Jason Saffert 2003 23rd Street Rice Lake, WI 54868

Amateur Owner Relationship to Horse Owner___________________________ STABLE WITH____________________________________________________ Emergency Phone_______________ (Send request for joint stabling Jason Saffert. Questions contact springcreekgrain@centurytel.net)

Include payment for stalls with entries, but only one stall fee is charged per horse for the entire show duration regardless of which shows you enter.

Reg Class # Qualifying for

Qualifying Class Name

Reg Class # Qualifying for

Show Name & Date Points or Placing

_______________________

Qualifying Class Name

_______________________

Points or Placing

***PHOTO COPIES REQUIRED of all Reg Papers, Both AHA and USEF Membership cards for all owners/riders/trainers ***

Make Checks Payable To: NCRCHA

Entry Form Must Be

Signed on Reverse Side

AHA ENTRY AGREEMENT I have read the rules concerning competitions as printed in the Arabian Horse Association (AHA) Handbook / Directory and Competitions Prize List and agree to be bound by and subject to those Rules.

AHA ASSUMPTION OF RISK, RELEASE AND INDEMNIFICATION This document waives very important legal rights. Read it carefully before signing. In consideration for AHA permitting me to participate in this Competitions, and by signing the entry blank, I agree as follows:

I AGREE that I choose to participate voluntarily in this Competitions, as a rider, driver, handler, lessee, owner, agent, coach, trainer, junior exhibitor, or as a parent or guardian of a junior exhibitor. I AM FULLY AWARE AND ACKNOWLEDGE THAT HORSE SPORTS AND PARTICIPATION IN THESE COMPETITIONS INVOLVE SERIOUS RISK OF HARM INCLU DING, BUT NOT LIMITED TO, RISKS OF ACCIDENT, SERIOUS BODILY INJURY, INCLUDING DEATH, BROKEN BONES, HEAD INJURIES, TRAUMA, PAIN, AND SUFFERING, AND PROPERTY DAMAGE. I ASSUME ALL RISKS OF HARM TO ME, MY HORSE, OR MY PROPERTY. I AGREE for myself, my heirs, executors, administrators, successors and assigns to release AHA, the Competitions, the facilities leased by the Competitions and the owner(s) of the facilities, and all of their respective officers, officials, directors, employees, agents, personnel, volunteers, affiliated organizations and insurers (collectively, the "Released Parties") from any and all claims for damage, loss, or injury to myself, other persons, horses or other property belonging to me to the fullest extent permitted by law that arises out of or relates in any way to the Competitions and my participation in the Competitions INCLUDING, BUT NOT LIMITED TO, DAMAGES, LOSS, OR INJURY RESULTING FROM ANY ACTS, FAILURE TO ACT, NEGLIGENCE OR NEGLECT OF OTHER ENTRANTS, THE RELEASED PARTIES, THEIR CONTRACTORS OR INVITEES, as well as for theft, vandalism, fire, other casualty damage, or damage arising out of any defects in the premises. I AGREE to indemnify and hold harmless (that is pay all losses, damages, attorneys fees and costs of) the Released Parties from and against any and all claims, demands, penalties, actions, losses, costs, damages, injuries, liabilities and obligations (including attorneys fees) of whatsoever kind and nature, which may be asserted against or incurred by any of them as a result of (1) my participation in the Competitions or (2) any act, failure to act, or neglect (a) by me, my agents, employees, riders, handlers, trainers, coaches, drivers, contractors or invitees, or (b) by any animal owned or exhibited by me or in my custody or control. I AGREE and represent that I am qualified and eligible to enter and/or participate in the Competitions, and every horse I am entering is qualified and eligible as entered. I AGREE to accept AS FINAL any decision of AHA, the Show Commission or Show Officials concerning my qualification or the qualification of my horse to enter the Competitions or any results of the Competitions, except to the extent that the Rules of AHA, the Competitions, EC or U.S. Equestrian Federation permit a protest or hearing of such decisions. Should a hearing be requested, I agree to accept AS FINAL the decision of the particular hearing body. I agree to release, hold harmless and not to sue AHA, the Competitions Sponsor, their officers, directors, employees, volunteers or members concerning any decision of AHA, the Competitions, its Show Commission, Show Officials or any hearing body that relates to my qualifications or my horse(s)’ qualifications to enter the Competitions or any results of the Competitions I AGREE that AHA has the sole right to control, sell, supervise or give away (or assign to others the right to do so) the exclusive rights to broadcast, televise, reproduce, transmit and disseminate all or part of this event, and I agree that AHA may use or assign, in any way AHA sees fit, photographs, films, videos, audios, cablecasts, or other likenesses of me and my horse taken during the course of the Competitions for the promotion, coverage or benefit of the Competitions or AHA. Those likenesses shall not be used to advertise a product and they may not be used in such a way, which implies endorsement of any company, product, product category, or service. I hereby expressly and irrevocably waive and release any rights in connection with such use, including any claim to compensation, invasion of privacy, right of publicity, or to misappropriation. By signing below as a parent or guardian of a junior exhibitor, I consent to the child’s participation and agree to all of the above provisions, and further agree to assume all of the obligations of this AHA Assumption of Risk, Release, and Indemnification personally and on behalf of the child. This AHA Assumption of Risk, Release and Indemnification is governed by the Laws of the State of Colorado and is intended to be interpreted as broadly as possible. I agree that exclusive jurisdiction and venue (place) for any legal action against AHA, its officers, directors, employees, volunteers or agents shall be in the local district courts or the federal court of the State of Colorado. If any part of this agreement is determined to be unenforceable, all other parts shall remain effect. EC WAIVER – I hereby certify that every horse, rider, and/or driver is eligible as entered and agree for myself and my representatives to be bound by the Constitution and Rules of the Equine Canada at this competitions. It is hereby Licensed. that all equestrian sports involve inherent risk and that no helmet or protective equipment can protect against all foreseeable injury. Hereby accept this risk and hold harmless the EC, the competitions, their officials, organizers, agents, employees, and their representatives Federation Entry Agreement By entering a Federation-licensed Competition and signing this entry blank as the Owner, Lessee, Trainer, Manager, Agent, Coach, Driver, Rider, Handler, Vaulter or Longeur and on behalf of myself and my principals, representatives, employees and agents, I agree that I am subject to the Bylaws and Rules of The United States Equestrian Federation, Inc. (the “Federation”) and the local rules of (Region XI). I agree to be bound by the Bylaws and Rules of the Federation and of the competition. I will accept as final the decision of the Hearing Committee on any question arising under the Rules, and agree to release and hold harmless the competition, the Federation, their officials, directors and employees for any action taken under the Rules. I represent that I am eligible to enter and/or participate under the Rules, and every horse I am entering is eligible as entered. I also agree that as a condition of and in consideration of acceptance of entry, the Federation and/or the Competition may use or assign photographs, videos, audios, cable - casts, broadcasts, internet, film, new media or other likenesses of me and my horse taken during the course of the competition for the promotion, coverage or benefit of the competition, sport, or the Federation. Those likenesses shall not be used to advertise a product and they may not be used in such a way as to jeopardize amateur status. I hereby expressly and irrevocably waive and release any rights in connection with such use, including any claim to compensation, invasion of privacy, right of publicity, or to misappropriation. The construction and application of Federation rules are governed by the laws of the State of New York, and any action instituted against the Federation must be filed in New York State. See GR908.4. Federation 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 Arabian Springfest to the following: 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 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 caused by me or my horse to others, even if the Harm resulted, 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 at the Competition. I have read the Federation Rules about protective equipment, including GR318 and EV113, 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 assume all of the obligations of this Release on the child’s behalf. I AGREE that “the Federation” and “Competition” as used above includes all of their officials, officers, directors, employees, agents, personnel, volunteers and affiliated organizations. 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. I represent that I have the requisite training, coaching and abilities to safely compete in this competition. 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. BOD 1/23/11 Effective 12/1/11 Is Rider/Driver/Vaulter a U.S. Citizen: Yes __ No

Rider/Driver/Handler (Mandatory) Owner/Agent (Mandatory) Trainer (Mandatory) Signature:

Signature: Signature:

Print Name:

Print Name:

Print Name:

Rider/Driver/Handler (Mandatory) If Rider/Driver/Handler is a Minor (Mandatory) Coach (if applicable) Signature:

Parent/Guardian Signature:

Signature:

Print Name:

Print Parent/Guardian Name:

Print Name:

Rider/Driver/Handler (Mandatory) If Rider/Driver/Handler is a Minor (Mandatory) Rider/Driver/Handler (Mandatory) Signature:

Parent/Guardian Signature:

Signature:

Print Name:

Print Parent/Guardian Name:

Print Name:

“EXPERIENCEA TRADITION”

Don’t forget to visit www.NRCHA.com

for a FREE nationalmembership!

Please mail membership applications to: Sue Nash2241 Gowan Avenue SW

Wavery, MN 55390

Stabling Request Form

Please send stall requests to:

Jason Saffert 2003 23rd Street

Rice Lake, WI 54868 springcreekgrain@centurytel.net

(715) 651-0586

Send stall payment with entries to:

Hannah Clevenger

18220 120th Avenue Indianola, IA 50125

whiteoakbarn@yahoo.com

(515) 971-5550

Priority stabling will be granted to paid show patrons and by postmark of entries.

Stalls will be available 8:00am on Wednesday, June 19th. Early arrivals must make arrangements with Jason Saffert at 715.651.0586 or at springcreekgrain@centurytel.net

Stabling Fee (Wednesday thru Sunday) $120 Stall Fee (one day) $60 Each subsequent night $40

Shavings @ $8.00/bag. No straw allowed on grounds.

--------------------------------------------------------------------------------------------------------------------- Responsible Party: ______________________________________________________ Phone: ________________________ E-mail: ________________________________

Trainer’s Name/Barn/Stable:_______________________________________________ To be stabled with: ______________________________________________________ # Stalls Requested: __________________ $ ______________ # Bags of Shavings: _________________ @ $8.00/bag $ ______________

Total Amount Due: _____________________ (Send all payments to Hannah Clevenger at address above.)

Declaration Form

Firecreek Farwa Versatility Award The winner of the Firecreek Farwa Versatility Award has the highest combined total points from a combination of classes to include Cutting (herd work may substitute for cutting), Reining (must be an actual reining class, not dry work of reined cow horse class), Working Cow (may use the fence work score from reined cow horse class), Trail, Ranch Pleasure, Western Riding, and Performance Horse Halter held during Thursday, Friday or Saturday competition. Must enter and show in at least three categories of the listed categories. One of which must be cutting, reining or working cow. Each category of class may only be used once; however, the show office will base calculations on scores from each horse’s highest placing class. Scores from both open and amateur classes will count toward final total score. Firecreek Farwa Versatility Award is given to both an Arabian and a Half-Arabian Champion and Reserve Champion. This declaration form must be on file in the show office before points will be awarded. In addition a copy of the appropriate registration papers must be on file in the show office. Horse Name: ___________________________________________________________ Registration Number: __________________________ Entry Number: _______________________________ Owner’s Name: _________________________________________________________ Owner’s Address: ____________________________________________ ____________________________________________ City: _________________________ State: ___________ Zip: _________

Award presentation to be Saturday night.

Barker Creek All-Around Performance Award

Declaration Form The winner of the Barker Creek All-Around Performance Horse will be awarded based on the highest combined total of points earned from any combination of classes to include: Working Cow Horse, Reining, Cutting, Herd Work, Trail, Ranch Pleasure and Western Riding held during Thursday, Friday or Saturday competition. Individual “goes” from the Bridle Spectacular, Derby or TUF Futurity/Maturity will count as individual classes. To be eligible for the award, horses must enter the performance halter class and at least one of the working events. Open to any breed of horse. This declaration form must be on file in the show office before points will be awarded. Champion and Reserve Champion trophy belt buckles will be awarded to the horses with the highest combined total of points from earned scores. In addition, a 60/40 jackpot will be distributed to the Champion and Reserve from a percentage of entry fees from the Performance Horse Halter class. First place in any eligible class will receive 10 points, second receives 9 points and so on until tenth place receives 1 point. Horse’s Name: _______________________________________________________________ Horse’s Entry Number: _____________ Owner’s Name: ______________________________________________________________ Address:_____________________________________________________________________ City: ____________________________________ State: ____________ Zip: __________

Please be sure you have signed up for the All-Around Performance

Horse Halter class to be held as the last class of Thursday, June 20th in the

outside arena. Entry Fee: $20

One-half of halter entry fees will be paid back at the rate of 60/40 to the Champion & Reserve Champion of

the Barker Creek All-Around Performance Horse Award.

Awards to be made Saturday night.