WNRDC Jumper Series Entry Form

Show information

Online entry – you must agree and select this item to proceed

Processing fee *

Online processing fee ($5.00) (Non refundable)

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Show date I’m entering

12 July 2022

26 July 2022

09 August 2022 (Cancelled due to heat)

23 August 2022

RIDER INFORMATION

Rider’s Name *

I am 18 years old or older *

Yes

Parent or legal guardian’s name *

Parent or legal guardian’s phone number *

Rider’s Email *

Rider’s Phone *

Rider’s Street Address *

Address Line 2

City *

State *

ZIP *

Emergency Contact Name *

Emergency Contact Phone *

Trainer’s Name *

Trainer’s Phone

Barn’s Name/Address *

Person/Barn trailering with *

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Horse Information

Horse’s Name *

Horse’s Breed *

Horse Color *

Horse Height *

Horse Gender *

Mare

Gelding

Horse Age or DOB *

Horse’s Owner *

Horse Owner’s Phone *

Coggins Report (mandatory, please send via email to show secretary ([email protected]) if unable to upload.

ACCEPTABLE COGGINS: WITHIN ONE YEAR OF EVENT

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I will be riding more than one horse (separate entry for each horse, please)

Yes

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Division Entering

Rider’s Age Category

JUNIOR (under age of 18)

SENIOR

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CLASS LIST

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Requests

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Series Secretary is Beth O’Malley: [email protected]

By submitting this form and payment I enter the WNRDC Jumper Series which is made at my own risk and subject to the conditions of the sponsoring Club. Further, in doing so, I understand that this competition can be dangerous for both horse and rider, including sickness and disease (including communicable diseases.) In addition, I release the West Newbury Riding and Driving Club, its members, all volunteers, the Town of West Newbury, landowners and organizers from any and all liability actions, causes of action, claims and demands of every kind and nature whatsoever which may arise in connection with or resulting from participation in any activities. I also give permission for the WNRDC to use any photograph, video or other likeness of me and my horse taken during the WNRDC Jumper Series for promotion, coverage or benefit of the club, with the condition that such likeness will not be used to commercially promote any product. 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. I have read the WNRDC COVID-19 Safety Protocols and agree to adhere to these guidelines and understand that they may change as CDC and state regulations change and that WNRDC requirements may be more stringent than CDC or State requirements. By typing my name below I agree. (If under 18 parent must electronically sign by typing their name.)

Electronic Signature *

Parent or legal guardian electronic signature if you are under 18 years of age *

Date *

My Horse’s coggin’s papers *

I have attached my horse’s Coggins

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Payment Info

Payment Total

Credit Card *

Cardholder Firstname *

Cardholder Lastname *

Cardholder Email *

Cardholder Address *

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WNRDC notes