Dressage Show Entry Form Please enable JavaScript in your browser to complete this form.Name of Show *Date of Show or Clinic *Date of EventRIDER Name *FirstLastName of RiderRider's Mailing Address *Rider’s Mailing Address: Street/PO Box Apt # etc/City/State/zipRider's Email *EmailConfirm EmailRider’s Email – How to contact with Ride Times, etc.Rider's Phone Number *Rider’s Phone (###) ###-####Professional/Open/Adult Amateur/Junior/Young Rider *Rider’s Status: Junior/Young Rider/Adult Amateur/Open Note: Adult Amateur as defined by USEF RulesRider's Membership Numbers *Rider USEF #/USDF/GMO/Chapter/WDAA/Chapter Example: USEF12345/USDF123/RMDS123/NCDA123 USEF12345/WDAA1234/WDACO1234 If no numbers, use 999 Emergency Contact Information *Emergency Contact: Name/phoneHORSE Full Registered Name/Barn Name and Information *Horse’s Full Registered Name/ Barn Name Breed/Sex/Height/Color/AgeVaccinations and Coggins Information *VACCINATIONS AND COGGINS – INCLUDE ATTACHMENTS most recent copy. Coggins valid within one year of show date. USEF Vaccine Log within 6 months of show date. Please note dates aboveHORSE Membership Numbers *Horse USEF #/USDF/GMO/Chapter/WDAA/Chapter Example: USEF12345/USDF123/RMDS123/NCDA123 USEF12345/WDAA1234/WDACO1234 If no numbers, use 999 OWNER'S Name *FirstLastName of Horse OwnerOwner Mailing Address *Owner Mailing Address: Street/PO Box Apt # etc/City/State/zipOWNER's Membership Numbers *OWNER’S USEF #/USDF/GMO/Chapter/WDAA/Chapter EXAMPLE: USEF12345/USDF123/RMDS123/NCDA123 USEF12345/WDAA1234/WDACO1234 If no numbers, use 999 TRAINER Name *FirstLastName of Trainer: Person responsible for the Horse during the show; must be 18 years of age or older and must be on the show grounds during the show. This Could Be You!Trainer's Phone Number *Trainer’s Phone (###) ###-####Trainer's Email *TRAINER Membership Numbers *TRAINER’s USEF #/USDF/GMO/Chapter/WDAA/Chapter EXAMPLE: USEF12345/USDF123/RMDS123/NCDA123 USEF12345/WDAA1234/WDACO1234 If no numbers, use 999 Classes from Show Prize Listclass name/divisionclass name/divisionclass name/divisionclass name/divisionFill in Class Name and Division StablingDay StallTack StallOvernightHaul In OnlyPlease check as needed. Please note if in a Group with Stalls. Rider/Owner responsible for Overnight Security. Facility may require physical presence.Show Fees *Office FeePer Class FeeDay StallTack StallOvernight StallHaul-In feeClass Sponsorship (Optional)Donation (Optional)USDF non-member fee per owner & riderUSEF (Non Member) Show Pass fee per owner, trainer & riderUSEF Fee per HorseUSEF Drug Fee per HorseOther Fees (eg. Local Membership fee, non Competing Horse, etc.)REFER TO PRIZE LIST FOR $$ AMOUNTS. Office Fee Required. USEF/USDF Fees as required if USEF/USDF recognized show. Questions? Please contact Show Secretary. Thank You!RELEASE, WAIVER AND HOLD HARMLESS AGREEMENT SIGNATURE RELEASESignatures *Rider/Driver/Handler/Vaulter/Longeur (mandatory)Is Rider/Dirver/Vaulter a U.S. Citizen (check if Yes)Owner/Agent (mandatoryTrainer (mandatory)Coach (If applicable)Parent/Guardian:print name/Sign (If applicable)Please PRINT then Sign Name. Submit
