Horse Show Entry Form (Use one form for each horse)

 

 

Name of Show-WPHC Paintbrush Summer Show – August 8, 2009 – 8:00 AM                               Office Use Only____________________

 

Name of Horse___________________________________________________Registration or License _._________________________________________

 

Date Foaled___________________________________________________________Circle One: Stallion        Mare        Gelding

 

Owner_____________________________________________________________Asso ID No_____________________________Exp Date____________

 

Address______________________________________________________________ Check here if this is a new address________________

 

City________________________________________________________________State_______________________________Zip____________________

 

Phone________________________________________________________________SSN_________________________________________________

 

 

Open Exhibitor________________________________________________________AssocIDNo____________________________ExpDate____________

 

Address_______________________________________________________________ Check here if this is a new address____________

 

City__________________________________________________________________State______________________________Zip___________________

 

Phone_________________________________________________________________SSN___________________________________________________

 

List class numbers to enter for this horse/exhibitor combination: _ _ ______ ________ ________ ________ ________ ________ ________ ________

 

 

Circle One:

Amateur or Youth Exhibitor_____________________________________________Amateur/YouthID#__________________________Exp Date___________

 

Address_____________________________________________________________ Birth date_____________________________

 

City_______________________________________________________________State_______________________________Zip_________

 

Phone_____________________________________________________________SSN___________________________________________

 

List class numbers for this horse/exhibitor combination: _______________ ________ _________ ________ ________ ________

 

________ ________ ________ ________ ________ ________ ________ _________

 

 

Who is responsible for the tab on this horse?_____________________________________________________________________

 

As an express condition of the privilege to participate at an association approved show or event, each owner, exhibitor, trainer, participant assume the risk of participation and release and discharge the breed association, state association its officers, directors, representatives and employees from any and all liability, whenever or however arising,  as to personal injury, or property damage occurring as a result of participation in an event conducted by the show or on the show grounds thereof.

 

Signature Owner/Exhibitor/Agent____________________________________________________________Date______________________________

 

Complete and return with copy of registration papers and membership cards by August 1, 2009 entry deadline to:

 

Michelle Winans, 2359 Coulter Drive, Cheyenne, WY 82009      Phone: 307-638-0569