prize list for the great american insurance group/united states

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1 PRIZE LIST FOR THE GREAT AMERICAN INSURANCE GROUP/UNITED STATES DRESSAGE FEDERATION REGION 5 DRESSAGE CHAMPIONSHIPS RECOGNIZED BY THE UNITED EQUESTRIAN FEDERATION, INC. Presented By October 5-7, 2012 Wasatch Event Center, Heber City, Utah A USEF Level 4 Dressage Competition USEF / USDF Recognition #329351 Recognized by: UDS, RMDS, IDEA, ADA Opening Date: August 20, 2012 Closing Date: September 10, 2012 USDF Region 5 Final Qualifying Date: September 10, 2012 ENTER ONLINE at WWW.2WHITEFEET.COM! Manager: Simone Windeler, 719.540.2000; cell: 719.287.2040 [email protected] Secretary: Heather Petersen, 12395 Gull Lane, Peyton, CO 80831, 719.683-8435, cell: 719.338.0854, [email protected] Judges: Maryal Barnett (S), MI; Melissa Creswick (S), CA, Lois Yukins (S), MA, Cara Whitham (S), CAN TDs: Joyce Hardesty (R), Rebecca Lewis (R) Announcer: Frank Waters Vet: South Valley Vet Clinic – on site information will be posted Farrier: Shayne Carter EMT: Ken Kerwin Licensee: The Collectives. Alison Child and Margo Gogan Stable Manager: Carol Kounanis Awards: Susan Gregg Volunteer Coor: Judy Hicks Photographer: Kathleen Bryan Videographer: CR Productions Show Office: 719.338.0854 The Official Prize List of the Great American/USDF Region 5 Dressage Dressage Championship appears in the USDF Regional Championship Official Prize List webpage and may be obtained after May 1, 2012 from the USDF web site at www.usdf.org http://www.usdf.org or by calling USDF at 859-271-2277.

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Microsoft Word - 2012 Championship Prize List[1].DOCSTATES DRESSAGE FEDERATION REGION 5 DRESSAGE CHAMPIONSHIPS RECOGNIZED BY THE UNITED EQUESTRIAN FEDERATION, INC.
Presented By
October 5-7, 2012 Wasatch Event Center, Heber City, Utah A USEF Level 4 Dressage Competition USEF / USDF Recognition #329351 Recognized by: UDS, RMDS, IDEA, ADA Opening Date: August 20, 2012 Closing Date: September 10, 2012 USDF Region 5 Final Qualifying Date: September 10, 2012 ENTER ONLINE at WWW.2WHITEFEET.COM! Manager: Simone Windeler, 719.540.2000; cell: 719.287.2040 [email protected] Secretary: Heather Petersen, 12395 Gull Lane, Peyton, CO 80831, 719.683-8435, cell: 719.338.0854,
[email protected] Judges: Maryal Barnett (S), MI; Melissa Creswick (S), CA, Lois Yukins (S), MA, Cara Whitham (S), CAN TDs: Joyce Hardesty (R), Rebecca Lewis (R) Announcer: Frank Waters Vet: South Valley Vet Clinic – on site information will be posted Farrier: Shayne Carter EMT: Ken Kerwin Licensee: The Collectives. Alison Child and Margo Gogan Stable Manager: Carol Kounanis Awards: Susan Gregg Volunteer Coor: Judy Hicks Photographer: Kathleen Bryan Videographer: CR Productions Show Office: 719.338.0854 The Official Prize List of the Great American/USDF Region 5 Dressage Dressage Championship appears in the USDF Regional Championship Official Prize List webpage and may be obtained after May 1, 2012 from the USDF web site at www.usdf.org http://www.usdf.org or by calling USDF at 859-271-2277.
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OPEN SHOW INFORMATION • In the Musical Freestyle Test of Choice be sure to list level on entry and include copy of 60% or better technical
test. • Open show classes/divisions with less than 4 entries may be canceled or combined. • Management will do its best to schedule specified Open classes before Championship classes where
appropriate. Great American/USDF Region 5 2012 Championships Qualifying Dates: 10/4/2011 Through 9/10/2012 See www.usdf.org for more rules regarding the Great American/USDF Championships Regional Championship Rider Change of Region Timeline Extended! Regional Championship riders who wish to change their region have up to July 1 to do so with no fee; from July 2 through August 1 with a $100 late fee; and from August 2 up to the closing date of the Region in which they intend to compete, for a late fee of $300. Please visit the USDF for a copy of the current form. Dressage Seat Medal Semi Finals (13 and under; 14-18):
A competitor may qualify by earning a qualifying score of 70% or better in a dressage seat equitation class between August 1, 2011 and July 31, 2012 or if a rider is qualified to compete in the Great American Insurance Group/USDF Regional Championships, then they may compete in the Dressage Seat Medal Semi Finals.
Management Rules and Procedures • During the competition, the performance arenas will be open to hand walking only up to one half hour prior to the
start of the first class. No horses will be allowed in the performance arenas during breaks. On Wednesday and Thursday, priority will be given to arena setup and maintenance, however, schooling will be allowed on a limited basis in all arenas on Thursday. Schooling will be allowed in performance arenas each evening if competition management deems it appropriate footing and weather.
• Both bridle numbers should be worn on each side of the horse when out of the stall. One bridle number is always required.
ALL dogs must be leashed and attached to a person or immovable object at all times! $50 fine for all violations. EVERY CLASS OFFERED HEREIN WHICH IS COVERED BY THE RULES AND SPECIFICATIONS OF THE
CURRENT USEF RULEBOOK WILL BE CONDUCTED AND JUDGED IN ACCORDANCE THEREWITH. Open show entries accepted on first come first served basis, based on the postmark or date stamp with dates on and
between open and close dates. Email, fax, snail mail and online entries accepted with valid payment. Sharps containers will be available in the stabling area and also in the show
office for trailer in horses. Competition management may fine any individuals including trainers, owners, exhibitors, or their agents up to $100 for improper disposal of needles or other sharp disposable instruments.
Post entries accepted on first come first served basis with space available, including open and USDF Region 5 Championship classes. Priority will be given to Championship Classes for post entries.
Wait list will be maintained through Tuesday 8pm Management reserves the right to:
Add or cancel judges Combine, divide, limit or cancel classes Refuse entries for cause. Waive penalty fees
NO SMOKING IN BARNS. • Schooling (out of competition) horses may be brought to the show but must be
registered on an entry form, with signatures and appropriate fees. Areas where they may be ridden in will be restricted, and priority given to horses in competition. Check with the show office for details.
• Riders may compete in only ONE division, no cross entering divisions: You must choose either Open or Adult Amateur or Junior. Exception: you may cross enter into the GREAT AMERICAN/USDF Qualifying division.
• All horses entered in competition must have a USDF HID or Lifetime registration. All riders and owners must have a USDF nonmember IDid, Group membership, or Participating membership and/or pay appropriate nonmember fees. All riders and owners must also have a USEF membership or pay appropriate nonmember fees.
• All horses in USDF Region 5 Championship classes MUST be lifetime registered with USDF and Annual or Lifetime registered with USEF; owners and riders must be current USDF PM or BM members and USEF competing members. These memberships must be in place at the time Qualifying scores are earned.
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TIMES Provisional ride times will be mailed to riders if a SASE is included with your entry and they will be posted at the Region 5 website www.usdfregion5.org , and www.twowhitefeet.com. Official times will be posted at the show office by noon on Thursday. ENTRIES and FEE
Open Classes (T-4): $40 FEI/MFS $45 All Championship classes: $70 Dressage Seat Medal Semi-Finals: $40 GREAT AMERICAN/USDF Qual. for 2013: $10 per class Post Entries: $20 taken on space available ANY CHANGES MADE AFTER CLOSING DATE will be charged: $25 Office Fee: $50 per horse/rider combination ($25 per non-compete horse) Haul-in Fee: $25 per horse per day (only if not doing stall/paddock) USEF Drug fee: $16 (drugs & medications $8; USEF $8) USEF non-member fee: $30 USDF Affidavit Fee: $5 USDF Non member Fee: $20 RV hook up fee: $35/night Bad Check Fee: $50 INCLUDE WITH ENTRY:
For Test of Choice Classes, state level and division on entry blank. Copies of USDF/USEF membership cards MUST be included with entry. All out of state horses must have a current health certificate (within 30 days of show date
Make checks payable to The Collectives and mail to Heather Petersen. If you are mailing overnight, please waive the required signature for delivery – If you do not waive the signature, you will be charged $5.
REFUNDS The office fee is non-refundable. Entries cancelled on or before the closing date will receive a refund of all fees except the office fee. No refunds if cancelled after the closing date unless ride is filled from waitlist. Waitlist maintained through Monday, October 1, 2012. No refunds of any kind for any reason including Acts of God from Wednesday, October 3 through Sunday October 7, 2012. IMPORTANT: All cancellations must be made in writing and mailed, faxed, or e-mailed to show secretary. You are responsible to confirm that your cancellation has been received. Anyone not appearing for any of their dressage tests without prior notification to the show secretary will be “scratched” from their remaining classes. Those rides will be filled if possible. STABLING – Bedding not included
Haul-in fee: $30 per day (only if not doing a stall or paddock) Day Stall: $30 (6am – 6pm) Overnight Stall: $35 (must be out by noon next day!) Overnight Tack Stall: $35 (must be out by noon next day!) Weekend Stall: $125 (Thurs- Sun, Wed – Sat, 4 nights total) Weekend Tack Stall: $125 (Thurs- Sun, Wed – Sat, 4 nights total) Extended Weekend Stall: $150 (Weds – Sun) Extended Weekend Tack: $150 (Weds – Sun) Day stalls and overnight stalls may be stabled in separate area from package stalls. Stalls are 12x12 permanent stalls with full sliding doors; stall fronts (including doors) are solid from midway down and bars
from midway up. Bedding and feed can be purchased on the grounds; Please contact the Carol Kounanis for more information. (801) 592-2750. Stalls and Paddocks will be available at 12:00 noon on the Wednesday prior to show weekend. If you desire other
arrangements, you MUST speak with Carol prior to sending your entry. Priority will be given to stalls for horses before tack stalls if stabling fills.
All horses competing in Regional Championship classes must remain on the competition grounds from the time of entry to the grounds and for the duration of their Regional Championship classes. If required to remain overnight, horses must be stabled on the competition grounds.
Bedding is $11 per bag. All bedding orders will be handled by stabling coordinator Carol Kounanis. Pre-orders must be emailed to [email protected] by 4pm Monday October 1st.
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Outside bedding will not be allowed on the show grounds. OFFICE HOURS • Thursday, 12 Noon to 6:00 PM; • Friday through Sunday 7:00 AM until 1 hour after final ride or as posted in show office. AWARDS
• Open Show Classes: Ribbons through sixth place, first place prize. • No awards or ribbons for qualifying divisions. • Other fun & special awards may be awarded during the show, look in the show program for details. • Breed associations and individuals are being contacted for breed awards as well, not all breeds may be represented. Send
in a copy of your registration papers with entry to be eligible for these awards. • Class #206 – Dover Adult Amateur Award – Second Level Test 3. For more information on the USDF/Dover Adult
Amateur Medal Program, please go to http://www.usdf.org/Programs/DoverAdultAmateurMedal.asp. • Awards for the Great American/USDF Regional Dressage Championships: Necksashes and prize money to Champion
and Reserve, Jacket and cooler to Champion, saddle pad to Reserve, ribbons to eighth place. • Prize Money for the nine Great American/USDF Regional Championships will be paid directly by the USDF office to
the recorded horse owner within 30 days of the last day of each championship. Champion and Reserve Champion in all levels and divisions (Open, AA and Jr/YR) of the 2012 Regional Championships will receive prize money. 60% of Prize money will go to the Champion and 40% of the prize money will go to the Reserve Champion. 2012 prize money amounts are $279 for Champion and $186 for Reserve Champion.
• DSM (Dressage Seat Medal) Semi-Final . Semi-Final awards will include trophy and ribbon supplied by the United States Dressage Federation. USEF will send medal applicable recipient. Champion and Reserve in each age division are eligible to compete in the national finals.
• A tentative schedule for the Awards ceremonies will be printed in the Show Program and the official schedule will be posted in the show secretary’s office by noon on the day prior to the beginning of the competition.
GREAT AMERICAN/USDF REGIONAL CHAMPIONSHIP AWARDS CEREMONY Riders placing in Great American/USDF Regional Championship classes must be present, mounted and in full riding attire for award ceremonies (Eight places for all Championship classes). Failure, without prior permission of the competition manager, in consultation with the Technical Delegate, the Awards Coordinator and the USDF representative, to be present and properly attired, will eliminate the official score and placing and the next highest score will move up in placing. In the case of inclement weather, unmounted ceremonies may be held. White or black leg wraps or boots are required for all horses for awards ceremonies. Competitors who do not wish to participate in the victory round may be excused. ARENAS
• Arenas have all weather dirt/clay/sand mix footing. • All championship classes will be ridden indoors in a 20 x 60 arena. Open show tests will be ridden in an outdoor 20x60
arena. • Warm-up arenas have comparable footing. • NO LUNGEING in warmup arenas – use designated lungeing areas only. • Coaching may be done from the outside of the arenas ONLY. • Competition arenas will be open for schooling on set-up day, the Thursday before the show, until posted close time in
show office. Limited schooling may be available in the evening by management decision. Hours and availability will be posted in the show office.
ACCOMMODATIONS Holiday Inn Express (435) 654-9990* Homestead Resort (435) 654-1102 Zermott Reaort (435) 654-7032 *Please be sure to ask for the Dressage Championships Group Rate DIRECTIONS Hwy 40 becomes Main Street in Heber City. From Main Street head west onto 100 South. Proceed for 1.8 miles and then take a left on Southfield Road. Up on your left about .4 miles you will see signage directing you into the event center, parking and stabling.
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TENTATIVE CLASS SCHEDULE
O=Open A=Adult Amateur J/Y=JR/YR Q=GREAT AMERICAN/USDF Qualifying for 2013 – Only those classes ridden in Regional Championships may now be
used for Qualifying purposes (Applicable to the FEI TOC). Only one Q test may be ridden at each level per day. Please Note: The schedule below does not necessarily indicate the order of go for the classes.
** The classes marked with 2 ** will attempt to be scheduled prior to the Championship class for that level. FRIDAY Class Division Level/Test 101 O, A, J/Y, Q Training Level Test of Choice** 102 O, A, J/Y, Q Training Level Test of Choice 103 O, A, J/Y, Q First Level Test of Choice 104 O, A, J/Y, Q First Level Test of Choice 105 O, A, J/Y, Q Second Level Test of Choice** 106 O, A, J/Y, Q Second Level Test of Choice 107 O, A, J/Y, Q Third Level Test of Choice 108 O, A, J/Y, Q Fourth Level Test of Choice 109 O, A, J/Y, Q FEI Test of Choice 110 O, A, J/Y, Q Freestyle Test of Choice 111 O Para Equestrian TOC 112 O Three Year Old Fillies Materiale 113 O 3 Year Colts/Geldings Materiale 114 O 4&5 Year Old Mare Materiale 115 O 4&5 Year Stallion Materiale 120 O, Q GREAT AMERICAN/USDF Training Level Championship-Open 121 O, Q GREAT AMERICAN/USDF Second Level Championship-Open 122 A, Q GREAT AMERICAN/USDF Second Level Championship-Adult Amateur 123 J, Q GREAT AMERICAN/USDF Junior Team Rider Championship 124 O, Q GREAT AMERICAN/USDF Prix St. George Championship-Open 125 A, Q GREAT AMERICAN/USDF Prix St. George Championship-Adult Amateur 126 J, Q GREAT AMERICAN/USDF Prix St. George Championship, Junior 127 O, Q GREAT AMERICAN/USDF Intermediare 2 Championship-Open 128 AA,Q GREAT AMERICAN/USDF Intermediare 2 Championships – Adult Amateur 129 J/Y, Q GREAT AMERICAN/USDF Intermediare 2 Championships - Junior SATURDAY Class Division Level/Test 201 O, A, J/Y, Q Training Level Test of Choice** 202 O, A, J/Y, Q Training Level Test of Choice 203 O, A, J/Y, Q First Level Test of Choice** 204 O, A, J/Y, Q First Level Test of Choice 205 O, A, J/Y, Q Second Level Test of Choice** 206 O, A, J/Y, Q Second Level Test of Choice- Second Level 3 – Dover/USDF AA Medal 207 O, A, J/Y, Q Third Level Test of Choice 208 O, A, J/Y, Q Fourth Level Test of Choice 209 O, A, J/Y, Q FEI Test of Choice 210 O, A, J/Y, Q Freestyle Test of Choice 211 O Para Equestrian TOC 212 O Three Year Old Fillies Materiale 213 O 3 Year Colts/Geldings Materiale 214 O 4&5 Year Old Mare Materiale 215 O 4&5 Year Stallion Materiale 216 O Quadrille / Pas de Deux TOC 220 O, Q GREAT AMERICAN/USDF First Level Championship, Open 221 A, Q GREAT AMERICAN/USDF First Level Championship, Adult Amateur 222 J, Q GREAT AMERICAN/USDF First Level Championship, Junior 223 J, Q GREAT AMERICAN/USDF Third Level Championship, Junior 224 O, Q GREAT AMERICAN/USDF Fourth Level Championship, Open 225 A, Q GREAT AMERICAN/USDF Fourth Level Championship, Adult Amateur
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226 J, Q GREAT AMERICAN/USDF Young Rider Team Championship 227 O, Q GREAT AMERICAN/USDF Intermediare 1 Championship, Open 228 A, Q GREAT AMERICAN/USDF Intermediare 1 Championship, Adult Amateur 229 J, Q GREAT AMERICAN/USDF Intermeidare I Championship, Junior 230 O, Q GREAT AMERICAN/USDF Grand Prix Championship, Open 231 A, Q GREAT AMERICAN/USDF Grand Prix Championship, Adult Amateur 232 J, Q GREAT AMERICAN/USDF Grand Prix Championships, Junior 233 J Dressage Seat Medal Semi-Finals (13 and under) 234 J Dressage Seat Medal Semi-Finals (14-18) SUNDAY Class Division Level/Test 301 O, A, J/Y, Q Training Level Test of Choice** 302 O, A, J/Y, Q Training Level Test of Choice 303 O, A, J/Y, Q First Level Test of Choice** 304 O, A, J/Y, Q First Level Test of Choice 305 O, A, J/Y, Q Second Level Test of Choice** 306 O, A, J/Y, Q Second Level Test of Choice 307 O, A, J/Y, Q Third Level Test of Choice 308 O, A, J/Y, Q Fourth Level Test of Choice 309 O, A, J/Y, Q FEI Test of Choice 310 O Para Equestrian TOC 311 O Three Year Old Fillies Materiale 312 O 3 Year Colts/Geldings Materiale 313 O 4&5 Year Old Mare Materiale 314 O 4&5 Year Stallion Materiale 320 A, Q GREAT AMERICAN/USDF Training Level Championship, Adult Amateur 321 J, Q GREAT AMERICAN/USDF Training Level Championship, Junior 322 J, Q GREAT AMERICAN/USDF Second Level Championship, Junior 323 O, Q GREAT AMERICAN/USDF Third Level Championship, Open 324 A, Q GREAT AMERICAN/USDF Third Level Championship, Adult Amateur 325 J, Q GREAT AMERICAN/USDF Fourth Level Championship, Junior 326 J, Q GREAT AMERICAN/USDF Intermediare 1 Championship, Junior 327 O, Q GREAT AMERICAN/USDF 1st Level Freestyle Championship 328 O, Q GREAT AMERICAN/USDF 2nd Level Freestyle Championship 329 O, Q GREAT AMERICAN/USDF 3rd Level Freestyle Championship 330 O, Q GREAT AMERICAN/USDF 4th Level Freestyle Championship 331 O, Q GREAT AMERICAN/USDF Intermediaire Freestyle Championship 332 O, Q GREAT AMERICAN/USDF Grand Prix Freestyle Championship
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Name:_______________________________ Phone: ____________________________ Address: ________________________________________________________________ Exact wording of name of sponsor for the show program: _____________________________________________________________________
The Collectives Will Select ALL Prizes except those for Special Awards Open Show Classes $50 or $65 with a business card ad
Level you would like to sponsor ______ Division_____ Championship Show Classes $75 or $90 with a business card ad
Level you would like to sponsor ______ Division_____ Special Awards $75 or $90 with a business card ad This can be a Breed Award or Best Seat Award or something else creative! Title of award donating: ________________________________________
Mail check made out to The Collectives with this coupon to:
Alison Child 3001 Meadows Drive Park City, UT 84060
Thank you So Much for your support!
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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 _____________________________________________________________________. 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.
I hereby agree to release, indemnify and hold harmless USDF, officers, directors, agents and volunteers from and against any and all
loss, liability or damage arising from or because of, or in connection with, participation in this competition or related activities. I also hereby agree to release, indemnify and hold harmless the show management, show committee and members, officers, directors, agents, and volunteers from and against any and all loss, liability or damage arising from or because of, or in connection with, participation in this competition or related activities.
Pursuant to the Utah Equine Liability Act, 78B-4-201 to 203, et seq. , it shall be presumed that participants in equine or livestock activities are aware
of and understand that there are inherent risks associated with these activities. An equine activity sponsor, equine professional, livestock activity sponsor, or livestock professional is not liable for an injury to or the death of a participant due to the inherent risks associated with these activities. “Inherent risk” with regard to equine or livestock activities means those dangers or conditions which are an integral part of equine or livestock activities which may include: a0The propensity of the animal to behave in ways that may result in injury, harm or death to persons on or around them; b)the unpredictability of the animal’s reaction to outside stimulation such as sounds, sudden movement, and unfamiliar objects, persons, or other animals; c)collisions with other animals or objects; d)the potential of a participant to act in a negligent manner that may contribute to injury to the participants or others, such failing to maintain control over the animal or not acting within his or her ability. The Event Sponsor (The Collectives and the Utah Dressage Society, it’s officials, officers, directors, employees, agents, personnel, volunteers and affiliates) is not liable for an injury to or the death of a participant due to the inherent risks associated with these activities. Participants are not relying on Event Sponsor to list within this document all possible inherent risks or all risks of participating in any of the activities at any location.
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 to the following: 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. BOD 1/23/11 Effective 12/1/11
Rider/Driver/Handler/ Owner/Agent Trainer Coach Vaulter/Longeur (mandatory) (mandatory) (if applicable) (mandatory) Signature: Signature: Signature: Signature: Print Name: Print Name: Print Name: Print Name: Print Parent//Guardian Name: Is Rider/Driver/Vaulter a U.S. Citizen? Yes: _____ No: _____ Parent/Guardian Signature (Required if Rider/Driver/Handler/Vaulter/Longeur is a minor): Emergency Contact Name / Phone Number:
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