CLASSES

Great Southwest Equestrian Center Open Horse Show December 16, 2012

Entries received before Wednesday 12/12/2012 will receive a $10 credit. Entries received after Friday, 12/14/2012 will pay

$10.00 late fee. PAYMENT IS NOT REQUIRED UNTIL BACK NUMBER IS PICKED UP FROM SHOW SECRETARY

ENTRY FORM

Checks payable to: GSEC 2501 South Mason Rd., Ste. 100 Katy, TX 77450 Fax # 281-578-6651

NAME OF HORSE OWNER RIDER

COGGINS Acc. #: _________________ Date: _________ Lab:______________

___________________________________ Name

___________________________________ Address

___________________________________ City, State, Zip

Email______________________________

____________________________ ______ Name Age

___________________________________ Address

___________________________________ City, State, Zip Phone number ______________________

SECOND RIDER

____________________________ ______

Name Age

_________________________________

Address

___________________________________

City, State, Zip Phone

THIS ENTRY IS AN AGREEMENT THAT THE PERSON ENTERED, ALONG WITH THE OWNER, LESSEES, TRAINER, MANAGER, COACH AND HORSE: (1) THAT EVERY HORSE AND RIDER IS ELIGIBLE AS ENTERED; (2) THAT THE OWNER AND ANY OF HIS/HER REPRESENTATIVES WILL AGREE TO THE FINAL DECISIONS MADE BY THE MANAGEMENT AND HOLD THE COMPETITION OF THE GREAT SOUTHWEST SHOWS OPEN SERIES, GREAT SOUTHWEST EQUESTRIAN CENTER L.P., THEIR OFFICIALS, THE MANAGEMENT EMPLOYEES AND AGENTS HARMLESS FOR ANY INJURY OR LOSS SUFFERED DURING OR IN CONJUNCTION WITH THE COMPETITION, WHETHER OR NOT SUCH INJURY OR LOSS RESULTED, DIRECTLY OR INDIRECTLY, FROM THE NEGLIGENT ACTS OR OMISSIONS OF SAID OFFICIALS, EMPLOYEES, AGENTS, THE MANAGEMENT, GSEC, GREAT SOUTHWEST EQUESTRIAN CENTER L.P..

WARNING, UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.

PERMISSION FOR A MINOR TO SHOW:

MUST be signed if rider is under 18 years of age. Numbers will not be issued until this form is signed!

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 I hereby agree and accept responsibility there under for the participation of said minor. _____________________________________________________________ Signature of Parent/Guardian/Trainer

NUMBER (office use only)

ENTRY FEES

______STALLS @ $30.00 Includes one bag of shavings

______GROUNDS FEE $30.00

______CLASSES @ $10.00

ALL DAY FEE @ $50.00

up to 10 classes

NON—SHOWING FEE @ $20.00 MUST ALSO PAY GROUNDS/STALL FEE

OFFICE FEE @ $10 per entry

___ADDITIONAL SHAVINGS $11.00

RV HOOKUP @ $30.00/

NIGHT

LATE FEE @ $10.00

EARLY DISCOUNT $10.00

Other

Total

PLEASE STABLE WITH:

Trainer’s Name ____________________________________________________ Trainer’s Signature __________________________________________________ Where a minor exhibitor has no trainer, parent or guardian must sign and assume responsibility Exhibitor Signature _________________________________________________ (Must be signed by exhibitor, owner or his agent.)

Emergency Contact / Cell Phone No

.___________________________