Show Entry Form
Grady County Fairgrounds Chickasha, Oklahoma October 24th and 25th 2009
This Show is OPEN to all Registered Peruvian Paso Horses of all Registries
For More Information Or Questions: Please Contact:
Sandra Norman-Show Chairman
PO Box 249 Morrison CO, 80465
Phone 303-697-9567 Fax 303-697-9569
This entry blank constitutes an agreement that the person(s) making it and the horse(s) entered shall be subjected to the rules and regulations of the USPHA and the Grady County Fairgrounds. The undersigned certifies that every horse, rider and/or handler is eligible as entered and agrees fore himself and his representative(s) to be bound by the By-Laws and rules of USPHA and the Grady County Fairgrounds . The undersigned certifies that he/she is the owner or owner's authorized agent for each horse listed hereon. It is further certified that the undersigned has read and is familiar with the Premium List in connection with the show and the USPHA Rules, Breed Standards, By-Laws and agrees to be bound by all rules, conditions and regulations including but not limited to those which discuss liability, risk, damage, injury, responsibility and indemnity. The undersigned , for his/herself, heirs, assigns, executers and administrators, waives, releases and discharges the USPHA the Grady County Fairgrounds, their officials, directors and employees from any and all injuries sustained by the undersigned including injury to or from animals and all claims of any kind or nature that might occur as a result of or arising from participation in this event. It is also certified there is no business relationship or conflict of interest between the Owner or Agent and the Judge of the Show.
Signature of Owner/Agent:____________________________________
Owner's Printed Name:_______________________________________
Street Address;_____________________________________________
City:_________________________ State:_______________ Zip:_________
Email:_____________________________
Telephone:_____________________________ Fax:________________________
Consent For Minor Participant
I hereby consent to the entry of my child in the horse show and certify that I have read the foregoing representations and statements and statements that the same may be deemed a part hereof, and hereby accept responsibility there under for the participation of said minor.
Child's Date of Birth:_____________ Signature of Parent/Guardian:________________________
Declaration of Amateur Status
I have read the requirements for Amateur Status in the USPHA Blue Book of Showing and declare that I am qualified to show as an Amateur in this show. I understand I will not be allowed to compete in Professional-Only Classes.
Signature of Amateur Competitor:___________________________ Date:__________
Declaration of Professional Status
I have read the requirements for Professional Status in the USPHA Blue Book of Showing and declare that I am qualified to show as aprofessional in this show. I understand I will not be allowed to compete in Amateur-Only Classes.
Signature of Professional Competitor:____________________________ Date: __________
Arrival / Stalling
Ranch Name :_____________________________________
Phone:__________________ Owners Name:___________________________________
Would like to be stalled close too:________________________________________
Arrival Date/Time:____________________ / Departure Date:_________________
Number of Horse Stalls:______ Tack Stalls: _______
You will receive one bag of Bedding for each horse stall. Additional bags will available at $7.50 per bag
I would like to include an End stall if available_________________
We will make every effort to accommodate everyone. Requests will be based on date received and complete payment.
Number of Classes________ Entry at $ 35.00 Per Class $_____________
Juniors____________ at $20.00 Per Class $_____________
Number of Horses_______ Late Fee $10.00 Per Horse $____________
Tack Stalls ______________ $65.00 Per Stall $___________
Horse Stalls______________ $65.00 Per Stall $___________
Early Stalls______________ $20.00 Per Stall $___________
Additional Horse Bedding _____ $7.50 per bag $___________
Office Fee $ 5.00______
Security Fee per horse _______ $ 5.00 per horse $___________
Drug Testing Fee $5.00 per horse $___________
I want to sponsor class(s)__________ Class Sponsorships $___________
Type of Advertising______________________ $ ___________
Total Amount Enclosed $____________
Make all checks payable to USPHA and mail to PO Box 249 Morrison, CO 80465
One owner Per entry form. Entry Deadline October 10, 2009
| Name | Ranch Name |
| Address | Phone |
| Fax | E-mail |
| Office Use | Name of Horse | Sex | Class Number | Rider / Handler | Fee |
| Registry Reg. Number | Date of Birth | Class Number | Rider / Handler | Fee | |
| Sire | Dam | Class Number | Rider / Handler | Fee |
| Office Use | Name of Horse | Sex | Class Number | Rider / Handler | Fee |
| Registry Reg. Number | Date of Birth | Class Number | Rider / Handler | Fee | |
| Sire | Dam | Class Number | Rider / Handler | Fee |
| Office Use | Name of Horse | Sex | Class Number | Rider / Handler | Fee |
| Registry Reg. Number | Date of Birth | Class Number | Rider / Handler | Fee | |
| Sire | Dam | Class Number | Rider / Handler | Fee |
| Office Use | Name of Horse | Sex | Class Number | Rider / Handler | Fee |
| Registry Reg. Number | Date of Birth | Class Number | Rider / Handler | Fee | |
| Sire | Dam | Class number | Rider / Handler | Fee |
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