2016 OPL ENTRY FORM DRESSAGE COMPETITIONS

2016 OPL ENTRY FORM
DRESSAGE COMPETITIONS
OFFICIAL USE
Due
COMPETITION
Duplicate copies of Entry Form. One horse per entry form.
Non compete horses must complete entry. Signatures required.
Send to (Entry) Secretary. Form Date: February 1, 2016
Name
Date
Entry Complete Date
RIDER
OWNER
Street
Street
T/St/Zip
T/St/Zip
Phone
DOB (JrYR)
Email
Status
Phone
Citizenship
TRAINER
Email
PHONETIC
Emergency: Name / Phone
For Breed Show in Hand indicate Handler as Rider - If Unknown indicate Owner - Status: Open / JrYR / AA
HORSE
Pronunciation of difficult name(s)
Previous Name
Reg #
Breed
Sex
Height
Color
Coggins
Sire
Sire: Breed / Reg #
Sire: Owner
Dam
Dam: Breed / Reg #
Dam: Owner
Dam’s Sire
Year Birth
Country Birth
For Sale
Breeder
Coggins is required ~ Include Breed Papers with Entry for eligibility to breed specific special awards ~ Indicate USA, Canada, Mexico as Country Birth for eligibility for NEDA Born in America cash awards
NUMBER
RIDER
OR NON MEMBER FEE
NUMBER
USEF / USDF MEMBERSHIP NUMBERS / FEES
OWNER
TRAINER
COACH ON GROUNDS
OR NON MEMBER FEE
USEF
$30
$30
USDF
$25
$25
NUMBER
OR NON MEMBER FEE
NUMBER
OR NON MEMBER FEE
$30
NUMBER
HORSE
$30
Not Required
OR NON MEMBER FEE
Req only for Qualifying
and Champ classes
$25
Not Required
Include copy of all USEF and USDF membership cards or pay one Non Member Fee per person per show ~ Pay $5 Affidavit Fee for each missing copy of USDF Rider / Owner / Horse membership card
Missing card
Missing card
Missing card
Not Required
Not Required
USDF
$5
$5
$5
Affidavit
Affidavit
Affidavit
MISCELLANEOUS FEES
FEI FIELDS
FEI Rider #
FEI Horse #
FEI Passport #
CDI competitors must indicate Rider Cizenship above, fill out these three FEI fields, and pay $35 IHP Fee
CLASS ENTRY FEES
NUMBER
DESCRIPTION
Post Entry
Class Change
NonCompete
CDI IHP $35
RV/Camper
Paddock
Other Fee
Other Fee
ENTRY FEE
ADDITIONAL
FULL PAYMENT MUST BE INCLUDED WITH ENTRY
TOTAL USEF / USDF FEES
TOTAL CLASS ENTRY FEES
TOTAL MISCELLANEOUS FEES
TOTAL STABLING FEES
OFFICE FEE
DRUG FEE
(CDI)
(See Prize List)
$16 ($8 Drugs/Meds / $8 USEF)
$28 ($20 Drugs/Meds / $8 USEF)
TOTAL PAID
FORM TOTAL
Notes
Additional Fee for $10 USDF Qualifying Fee ~ NEDA $50 Sweepstakes Fee etc.
STABLING
Horse Name
STABLING NIGHTS
Horse Sex
Mon
Tues
Notes
Rider
Wed
Thurs
Notes
Stabling Group
Fri
Sat
Stall(s)
Horse Stall
Tack Stall
Lodging/Phone
Tack Stall must be same nights as Horse Stall ~ Pay Stall Deposit(s) with separate check
Sun
Depart Day/Time
Arrive Day/Time
STABLING FEE TOTALS
Stalls
# Stalls
x Fee
= Total
Shavings
# Bags
x Fee
= Total
Stall Deposit # Stalls
x Fee
= Total
Form Date: February 1, 2016
USDF CLAUSE
I hereby agree to release, indemnify and hold harmless USDF, its instructors, officers, directors, agents and volunteers from and against any and all loss, liability or damage arising from or because of, or in connection with, participation in this competition or related activities. I hereby agree to release, indemnify and hold harmless the show
management, show committee and members, officers, directors, agents and volunteers from and against any and all loss, liability or damage arising from or because of,
or in connection with, participation in this competition or related activities.
MASSACHUSETTS CLAUSE
Under Massachusetts law, any equine professional is not liable for injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine
activities, pursuant to section 2D of Chapter 128 of the General Laws.
USEF MEMBERSHIP STATEMENT
Life, senior active and junior active members shall be eligible to participate in all classes at Regular Competitions, Eventing Competitions at the Preliminary
Level or above and Combined Driving Competitions at the Advanced Level, Dressage, Reining and Vaulting Competitions and Endurance Rides. A non-member may participate as a handler, rider, driver, owner, lessee, agent, coach or trainer at Regular Competitions, Eventing Competitions, Dressage Competitions,
Reining Competitions and Combined Driving Competitions upon payment of a $30 Show Pass fee. Participants in the following classes are exempted from the
Requirements of this rule: 1) leadline; 2) exhibitions; 3) games and races; 4) classes for 4-H members; 5) walk trot and academy classes (academy classes
are classes limited to horses used regularly in a lesson program); 6) USDF introductory level tests, pas de deux and quadrille classes; 7) NRHA Endorsed
Reining Competitions. 8) Opportunity classes, 9) citizens of other nations who have proof, in English, of current membership in good standing of their own
National Federation, 10) USEA beginner novice division; and 11) assistant handlers in Dressage Sport Horse Breeding classes.(GR901.9)
USEF FEDERATION ENTRY AGREEMENT
By entering a Federation-licensed Competition and signing this entry blank as the Owner, Lessee, Trainer, Manager, Agent, Coach, Driver, Rider, Handler, Vaulter or
Longeur and on behalf of myself and my principals, representatives, employees and agents, I agree that I am subject to the Bylaws and Rules of The United States
Equestrian Federation, Inc. (the “Federation”) and the local rules of the competition. I agree to be bound by the Bylaws and Rules of the Federation and of the competition. I will accept as final the decision of the Hearing Committee on any question arising under the Rules, and agree to release and hold harmless the competition,
the Federation, their officials, directors and employees for any action taken under the Rules. I represent that I am eligible to enter and/or participate under the Rules,
and every horse I am entering is eligible as entered.
I also agree that as a condition of and in consideration of acceptance of entry, the Federation and/or the Competition may use or assign photographs, videos, audios,
cablecasts, broadcasts, internet, film, new media or other likenesses of me and my horse taken during the course of the competition for the promotion, coverage or
benefit of the competition, sport, or the Federation. Those likenesses shall not be used to advertise a product and they may not be used in such a way as to jeopardize amateur status. I hereby expressly and irrevocably waive and release any rights in connection with such use, including any claim to compensation, invasion of
privacy, right of publicity, or to misappropriation.
The construction and application of Federation rules are governed by the laws of the State of New York, and any action instituted against the Federation must be filed in
New York State. See GR908.4. (GR906.4)
USEF RELEASE, ASSUMPTION OF RISK, WAIVER AND INDEMNIFICATION
This document waives important legal rights. Read it carefully before signing.
I AGREE in consideration for my participation in this Competition to the following:
I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, directors,
employees, agents, personnel, volunteers and Federation affiliates.
I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as
parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and
serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”).
I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature
caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or the Competition.
I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition.
I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm
to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective
equipment, including GR801 and, if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation
strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to
the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the
requisite training, coaching and abilities to safely compete in this competition.
I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the
official USEF accident/injury report form.
BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank and all terms and provisions of this Prize
List. If I am signing and submitting this Agreement electronically, I acknowledge that my electronic signature shall have the same validity, force and effect as if I affixed
my signature by my own hand. (GR908.6)
SIGNATURES ARE MANDATORY
Entry will not be accepted without mandatory signatures, full payment, legible
proof of Coggins and other prize list requirements.
SIGNATURES ACKNOWLEDGE ACCEPTANCE OF PRIZE LIST REFUND POLICY
RIDER / DRIVER / HANDLER / VAULTER / LONGEUR
Mandatory
OWNER / AGENT
Mandatory
TRAINER
Mandatory
COACH
Mandatory for person on grounds who coaches Rider / Handler
PARENT / GUARDIAN
Required if Rider / Driver / Handler / Vaulter / Longeur is a minor
Is Rider / Driver / Vaulter a U.S. citizen?
CREDIT CARD INFORMATION
Mastercard
Billing Street
Visa
ENTRY FORM NOTES
Copies / faxes are acceptable. The word “same” and ditto marks will be rejected. Trainer
is person responsible for condition of horse and must be on grounds during show. Any
person on grounds who coaches Rider / Handler must sign this form as Coach.
Signature
Print Name
Signature
Print Name
Signature
Print Name
Signature
Print Name
Signature
Print Name
Yes
No
(Check Prize list to be sure this Competition accepts credit card payments ~ NEDA Spring, Summer, and Fall Shows accept only Mastercard and Visa)
Print name
Expiration
Number
of Cardholder
MM/YY
Security
Town / St / Zip
Code
AMOUNT
Signature
PREVIOUS COMPETITION SCORES FOR QUALIFICATION / ANNOUNCER
Competition
Date
Level / %
Competition
Date
Level / %