prix de villes hunter jumper entry form - Lake Erie College

PRIX DE VILLES HUNTER JUMPER
ENTRY FORM
COMPETITION DATES April 21-22, 2012
ENTRY
NUMBER
Only one entry per form. Checks payable to Lake Erie College
Please include Proof of negative Coggins (within 12 months of show date)
Rider Information
Name ____________________________________________
Address___________________________________________
City/State/Zip_______________________________________
Phone___________________ Email_____________________
Rider Signature______________________________________
Trainer/Coach Name _________________________________
Team Name________________________________________
Trainer/ Coach Signature______________________________
Please circle classes you wish to enter
Sweepstakes - $50 each
Class 1—Low Class 2–High
Class 3—Low Class 4—High
Owner Information
Name ________________________________________________
Address______________________________________________
City/State/Zip__________________________________________
Phone_____________________ Email______________________
Signature_____________________________________________
Horse Information
Name ________________________________________________
Breed_____________________________ Sex_______________
Color_________________________ Coggins Date____________
***Please attach a copy of the Coggins.
Total Class
Fees
Class 5—Junior Amateur High Performance—$60 (2’6”-2’9”)
Class 6– High Performance Hunter Derby—$60 (3’ 3’3” 3’6” 3’9” 4’0) please circle height
Team Competition—$130—- * Please complete Team data information on reverse side
Class 7—Low Team
Class 8—High Team
Recipient of Prize Money
Name ______________________________________________
Address____________________________________________
City/State/Zip________________________________________
Phone______________________________________________
Signature___________________________________________
Mail to: Lake Erie College
c/o PDV
391 W. Washington Street
Painesville, OH 44077
ENTRIES CLOSE APRIL 13, 2012
Stabling: $85 per weekend
$45 per day if available
Per Order Bedding
____ bags @ $9 per bag
Office Fee $20
Post Entry ($10)
Total
Most fees are nonrefundable.
See refund policy in prize list for details
Payment Information
By signing this entry form, I hereby enter the above listed horses at my own risk and subject to all rules of Lake Erie College. I further agree
that if any damage be occasioned or loss occurs to the horse exhibited, any vehicle, article, or person which I may send with the horses, I will
make no claim against Lake Erie College.
I will attend Exhibitor’s Party on Friday night April 20, 2012__________________(Please include Number of Guests)
Emergency Contact _________________________________________ Phone___ ______________________________

PRIX DE VILLES STADIUM JUMPING
TEAM DATA
Team Name_______________________________________
Coach/Trainer Name________________________________
Division (circle one)
Low High
List riders in order of go as stated in the prize list. (State whether junior, amateur, or professional status.)
Entry # Rider’s Name Status Horse’s Name Age Sex Breed
List riders in order of go, the first rider to go first, etc. as stated in the Prize List.
Every entry in the Jumper Prix de Villes agrees that the person making it, rider, coach, and owner, shall be
subjected to the rules and regulations of the show, and that every horse and rider is eligible as entered.
EACH RIDER must COMPLETE AN INDIVIDUAL ENTRY FORM (reverse side) AND THE RIDER DATA SHEET.
ENTRY FEES ACCOMPANY THE INDIVIDUAL ENTRY FORM.
The Prix de Villes and Lake Erie College employees will not be held responsible for any loss or damage to
persons, property, or horses. I agree that any of the information I have provided may be shared with any
sponsors of the Prix de Villes horse show.
________________________________________________
Coach’s Signature
___________________________________
Date