LPSDC League Show Entry Form

Lower Puget Sound Dressage Club - Chapter ODS
2015 League Show Entry Form
Check the show date you are entering (only one show/entry form and only shows open for entries)
 Saturday, May 2, 2015 at Green Hills Farm, Gig Harbor
 Sunday, May 3, 2015 at Green Hills Farm, Gig Harbor
 Saturday, June 6, 2015 at Sawda Equestrian Center, Port Orchard
 Sunday, June 7, 2015 at Sawda Equestrian Center, Port Orchard
 Sunday, July 12, 2015 Sawda Equestrian Center, Port Orchard
 Saturday, August 1, 2015 Sawda Equestrian Center, Port Orchard
 Sunday, September 6, 2015 Green Hills Farm, Gig Harbor
Please note “OPENING & CLOSING” dates for each show are listed in the Omnibus at www.lpsdc.com.
We will be accepting entries in the order received, until the show is full. Others will be put on a wait list.
Only ONE HORSE/RIDER combination per entry form.
Riders Information EVERYTHING IN THIS BOX MUST BE FILLED OUT OR YOUR ENTRY WILL BE SENT BACK.
Name ________________________________________________________ ODS Member Number ___________
Address _________________________________________________ City______________ State ____ Zip ______
Home Phone (
) _______-___________________
Cell Phone (
Emergency Contact _____________________________________
) ______-______________
Phone (
) _____-____________
Rider’s Email _______________________________________________________________
(Check one)
Open ___ Adult Amateur___ Jr/YR.___
Jr./YR Birth Date ______________ Age ______
Owner/Horse Information EVERYTHING IN THIS BOX MUST BE FILLED OUT OR YOUR ENTRY WILL BE SENT BACK
EVEN IF IT IS THE SAME INFORMATION AS ABOVE
Horse Name _______________________________________________________________
Owner Name ______________________________________________________ ODS Member Number ________
Address ________________________________________________ City ______________ State ______ Zip ______
Home Phone (
) _____-_____________________________ Cell Number (
) _____-_______________________
Owner’s Email ______________________________________________________________
Novice Rider (Members Only)
Let us know if you have shown dressage for less than two years in either…
Training Level _____ or Intro. Level ____
Releasor desires to engage in equine activities sponsored by or in which Releasor will be using equipment, facilities, and/or premises furnished by, Releasee.
Releasor understands there are inherent dangerous risks of serious injury or death in equine activities, and as a condition of participation in equine activities, Releasor
(individually and for his/her heirs, executors, assigns, invitees, and minor children) waives the right to bring, and releases Releasee and Releasee’s administrators,
agents, officers, directors, employees, predecessors and successors-in-interest, and any other persons or entities united in interest with Releasee from any and all
manner of actions, suits, claims for relief, demands, and any other obligations, known and unknown, suspected and unsuspected, in law or equity, direct or indirect,
and whether now or in the future, for any injury, loss, or death arising out of or connected in any way with riding, training, driving, boarding, grooming, or riding as
a passenger upon an equine. If for any reason any provision of this release is determined to be invalid, the remainder shall continue in full force and effect. This
release contains the entire agreement between the parties hereto and the terms of this release are contractual, not a mere recital.
Releasee: Oregon Dressage Society, Inc., Lower Puget Sound Dressage Club, Sawda Equestrian Center, Green Hills Farm, Silver Spur Club, Chalice Farms,
Washington State Horsemen
Releasor: the undersigned rider, parent or consenting adult on behalf of minor, trainer, owner, or agent of aforementioned.
By signing below, I ACKNOWLEDGE that I have read and understood this release, and I AGREE to be bound by it and all
applicable ODS rules. (MANDATORY SIGNATURES)
X_________________________________________ _________
Signature of Rider
Date
X______________________________________ _______
Signature of Horse Owner or Authorized Agent Date
“Trainer”: (MANDATORY SIGNATURE - Adult on grounds responsible for horse)
X_________________________________________ _______
Signature of “Trainer”
Date
Permission for Minor to Show (IF APPLICABLE)
I hereby consent to the entry of my child in this show and certify that I have read the foregoing representations and statement, and
that the same may be deemed a part thereof, and hereby accept responsibility there under for the participation of said minor.
X__________________________________________ ______
Signature of Parent or Guardian
Date
PLEASE LIST RIDES IN ORDER
OF PREFERENCE.
Riders are limited to two (2) classes.
A third class may only be allowed at the
scheduler’s discretion.
Please place your 3rd ride in box #3
marked “optional”.
X______________________________________________
Print Parent/Guardian Name
Class #
Level
Test
1.
2.
3.optional
Would you like to volunteer?
LPSDC League Show Entry Fees
Sign up on our website lpsdc.com
(No Entry will be accepted unless fees are enclosed.)
Would you like to Sponsor a Class?
Yes 
($10/class. Make separate check payable to LPSDC)
Level/Test ______/_______
Office Use Only
Number: ________
CLASS FEE………………………… $25 per test $ _________
Lead line Class……...............................$5 per rider$__________
Show Grounds Fee………………………………..$ ____10.00_
ODS Participation Fee (Required) ….$1 per test $ _________
(Note! All riders are subject to this fee)
Late Fee/Post-Entry. ………………..$10 per entry $ _________
Class Sponsorship…………………….$10 per test $ _________
Subtotal ……………………………………………$ _________
Check #:________ Split $__________ Entry #_______
Less Dressage $$ enclosed…………………………$(________)
AMT $: ________
Total Fees Enclosed……………………………….$ _________
Refund Due: ________
Make Checks Payable to: LPSDC
Mail Entry Form To:
Julie Paddock
3137 Wren Way, Poulsbo, WA 98370
Reason: ______________________________________
Questions? E-mail turtlehors@aol.com
Dr $$: < $________>
Everything filled out?
Rider ____ Minor_____ Owner _____ Trainer_____
(NO ENTRIES ACCEPTED BY EMAIL OR BY PHONE)
(All entries must be post marked or post dated not earlier than by
each show’s opening date and/or no later than closing date).