Dressage Form

Dressage Entry Form
one horse/rider combination per entry form. Entry fee must accompany entry. No refunds.

* Choose Show Date:

February 19 April 23 July 9 Oct 22

First Ride ($30)

Enter Test Choice

Second Ride ($30)

Enter Test Choice

Third Ride ($30)

Enter Test Choice

Add Nomination by the April show to qualify for Year End Awards ($10)

Add Stall ($10)

Grounds fee - non-members ($20)

Include Drug ($14)

CDS circuit fee ($3) Mandatory if entered in classes 1-7 one fee per horse/rider combo

* CDS Number (Only for CDS schooling circuit awards)

TOTAL ENTRY FEE

Rider & Horse Information

RIDER'S INFORMATION

* Rider's Name:

Address:

* Rider's Age if under 21:

City

State

Zip

* Cell#

* Enter Email Address:

*Re-enter Email Address:

Pony Club
Yes No

* FRF Member/Non-Member

HORSE INFORMATION

* Name of Horse:

* Date of last equine herpesvirus (rhinopneumonitis) vaccination:

Must be within six months prior to event.

I declare that the above named horse has been in good health, with rectal temperature below 102°F, eating normally and has not shown signs of infectious disease for the three (3) days preceding arrival at this event. I also declare that this horse has not had contact with any ill horses during the 21 days prior to the event.

SPECIAL SCHEDULING REQUESTS

Emergency Contact Info.

* Emergency Contact Name:

* Emergency Phone:

Fallbrook Riders Dressage Series, Fallbrook Riders Field, South Stagecoach Lane, Fallbrook, Ca 92028

PARTICIPANT’S RELEASE OF LIABILITY & HOLD HARMLESS AGREEMENT. THIS RELEASE CONTAINS IMPORTANT LIMITATIONS OF LEGAL LIABILITY. READ IT CAREFULLY BEFORE SIGNING.

The undersigned states as follows:
I recognize that competitive and pleasure horse activities possess inherent risks of injury and damage to me personally, to my children, to my horse(s), and to my equipment. Acknowledging these facts, I hereby, in consideration of your acceptance of this form, discharge and hold harmless Fallbrook Riders Inc., their boards of directors, officers, members, employees, and all other persons and organizations in any way connected with this event and their representatives, heirs, and assigns, executors, administrators from any and all right, claim or liability for damage or for any and all injuries that might be sustained by me or my children, including injuries to animals or from any and all claims of any kind or nature that I might have as a result of or arising out of my participation in any activity. I further acknowledge that his release will extend to any accidents, damages, or claims arising out of my participation by my own act or the acts of anyone or any animal within my control. I further agree that I will defend, indemnify, and hold harmless Fallbrook Riders Inc., their board of directors, officers, members, or any one of them against all claims, demands, and causes of action, including court costs and attorney fees directly or indirectly arising from any action, claim, or other proceeding brought by and prosecuted for my benefit contrary to this release, extending to all claims of every kind and nature whatsoever, whether know or unknown, and expressly waive any benefits I may have under Section 1543 of the California Civil Code relating to the release of unknown claims. I acknowledge that I have read and understand the foregoing liability and agree to the terms thereof.

* I acknowledge that I have read and understand the foregoing liability and agree to the terms thereof.

* SIGNATURE OF RIDER

Participant’s signature or signature of parent if participant is under 18 will be required at check in.

*Name on credit card used to pay for this entry in PayPal: