Rider’s Name _______________________________________Entry Number: __________
Birth Date ___________ Age Group: _______10 & Under _______11-13 _______14-17
Horses Name ______________________________Coggin's Accession # ______________
Dead Broke Youth Show
Registration and Liability Release Form
I hereby absolve and release the Dead Broke Saddle Club, and all the persons and parties connected with the horse
show, including all and any damages to my horse, equipment or attendance. I hereby agree to assume personal
responsibility for any damage caused by my horse or the members of my family, or employees in and during the horse
show. Additionally, I herby agree that if I shall be injured at any point in the show, I will not seek injury damages from
the saddle club or individuals involved with the show, but will look to my own personal health insurance.
Parent Name: ____________________________________ Date: ___________________
Street
City
State
Zip
Parent Signature: _________________________________________________________
DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY
1. Showmanship 10 & Under
2. Showmanship 11-13
3. Showmanship 14-17
4. Bareback 10 & Under
5. Bareback 11-13
6. Bareback 14-17
7. *Tandem Bareback
8. English Pleasure 10 & Under
9. English Pleasure 11-13
10. English Pleasure 14-17
11. English Equitation 10 & Under
12. English Equitation 11-13
13. English Equitation 14-17
14. Leadline 6 & Under
15. Western Pleasure 10 & Under
16. Western Pleasure 11-13
17. Western Pleasure 14-17
18. Open Snaffle Bit Western Pleasure
19. Western Horsemanship 10 & Under
20. Western Horsemanship 11-13
21. Western Horsemanship 14-17
22. Egg & Spoon 10 & Under
23. Egg & Spoon 11-13
24. Egg & Spoon 14 - 17
25. Pole Weaving 14 -17
26. Pole Weaving 11 - 13
27. Pole Weaving 10 & Under
28. Barrels 14 - 17
29. Barrels 11 - 13
30. Barrels 10 & Under
31. *Leadline Barrels 6 & Under
32. Jumping Figure 8~ 14 - 17
33. Jumping Figure 8~ 11 - 13
34. Jumping Figure 8~ 10 & Under
35. One-Barrel Pennant 14 -17
36. One-Barrel Pennant 11 - 13
37. One-Barrel Pennant 10 & Under
38. Key Race 14 - 17
39. Key Race 11 - 13
40. Key Race 10 & Under
41. Speed Dash 14 - 17
42. Speed Dash 13 & Under
43. *Rescue Race
Item
Qty
Classes
*Double Classes
Office charge
____
____
1
Total due
Cost
$4.00
$8.00
$5.00
Total
______
______
$5.00
$_________
Office crew initials ________