Latta Equestrian Center Open Horse Show Entry Form
(Please Print)
Name: _______________________________________
Street Address: ________________________________
________________________________
Phone#: ______________________________________
Email: _______________________________________
Stall: ____Yes ____No
If Yes, Stall #: _________
Rider #
Rider Name
Horse’s Name
Total # Classes ________ X $10.00/class = $_________________
+ Stall Fee $________________
+ _____shavings at $6.50/bag $________________
TOTAL AMOUNT DUE $________________
Owner Name/Farm
Class #
Latta Equestrian Center, staff, parents, judges, the show committee, Mecklenburg County, the county officers, agents and employees will not be responsible for any loss, cost, damage, expense or
liability of any kind from bodily injury, sickness, disease, including death, to any person or animal. We will not be responsible for any damage or destruction of properties, real or personal; arising
directly or indirectly from operations, products, or services provided in connection with this horse show.
All horses listed above and/or brought onto the grounds must have a current negative Coggins test.
Signature of Person Responsible: _________________________________________________ Date: _________________________