Liberty Hill Equestrian Center, d/b/a Liberty Hill Farm
Dressage Schooling Show Entry Form
Sunday April 23, 2017
Closing date Sunday April 16, 2017
HORSE’S NAME: ________________________________________________

RIDER’S NAME (print): _______________________________________________PHONE: ________________
   

Address___________________________________________________________________City&Zip_________________________

email ______________________________________________________Trainer (if applicable)____________________________

!!!!!!!   Division (circle one)      Open        Adult           13/over       12/under   !!!!!!!
No refunds will be issued or applied to future shows after in-hand date.
Management reserves the right to cancel or combine classes, change officials, or refuse entries
Boots and helmets mandatory (ASTM approved)USEF/USDF rules will be followed with regards to tack
Call Tim at 210-445-1931 or Kitch at 210-445-1935 for more information
Ride times posted at www.libertyhillfarm.net Friday afternoon
I agree that I am participating voluntarily in the above competition and am fully aware that horse sports and this competition involve
inherent dangerous risks of serious injury or death, and by participating I expressly assume any and all risk of injury or loss, including
death to myself and my horse and I agree to indemnify and hold Liberty Hill Equestrian Center, d/b/a Liberty Hill Farm (herein known as
LHF), it owners, agents, employees, and volunteers harmless from and against all claims including for any injury or loss suffered during
or in acts or omissions of said LHF, its owners, agents, employees, or volunteers.  I accept full responsibility for any and all medical
expenses I incur as a result of any injury I or my horse incur while partaking in this competition.  I will also be responsible for any and
all medical expenses incurred on my or my horse’s behalf by LHF including but not limited to ambulance fees, emergency room fees,
doctor/vet fees, and hospital fees.  I authorize LHF to authorize medical treatment on my behalf and on the behalf of my horse if I am
unable to do so. I assume all responsibility and liability for any and all family members and/or guests I bring with me to LHF.  I
represent that I have the requisite training coaching and abilities to safely compete in this competition. If I am a parent or legal guardian
of a junior (18 or under) exhibitor, I consent to the child’s participation and agree to all the above provisions and agree to assume all the
obligation of this Release on the child’s behalf.
WARNING:
UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE) A FARM ANIMAL PROFESSIONAL IS
NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN FARM ANIMAL ACTIVITIES RESULTING
FROM THE INHERENT RISKS OF FARM ANIMAL ACTIVITIES.
Rider’s Signature: ________________________________________________________________________
Parent/Guardian Signature if rider is under 18 ____________________________________________
Print Parent/Guardian’s Name__________________________________________________________
Trainer/Coach’s Signature_____________________________________________________________________
Emergency contact _____________________________relationship____________phone#__________________
(Schooling Fee $25.00  Must have coggins do not pay any other fees)
Fees
Tests ($25.00 per test)
 
   
   
   
Office Fee 30.00 ($5.00 refund for perfect entry)
$30.00
Late fees add $5.00 per class
 
Total Fees  (One check per entry, cash or money orders not accepted)
Attach current neg coggins report - one entry per horse / rider combination
Mail to Liberty Hill Farm 28525 Saxet Dr. Boerne, Tx 78006                   
 
Staple
check
here