Entry Form Information

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HORSE POWER FARM
233 Woodchuck Hill Road
Canterbury, CT 06331
860-334-1772
* www.horsepowerfarm.info *
CROSS COUNTRY DERBY
April 30, June 25, July 30, Oct 15, 2016
RULES AND GENERAL INFORMATION
1. The cross country course will be judged according to the current USEA rules. Your 1st round
will be your scoring round. An extra round may be added. Coaching by your trainer/coach is
permitted and encouraged during “extra round”. Assistance by Event Management is also
available on request.
2. Any horse/rider and division combination accepted.
3. Jump placement and courses will be changed for each derby.
4. All courses will open to walk on Friday at 3pm. Derby Day courses will be open 9 am and
close at 4:00 pm. Scoring will be posted after the last ride of the day. Ribbons 1st – 6th will be
mailed. Closest to Optimum Time ribbon will be awarded at each Derby. Series and special
awards will be presented at the last Derby of the year.
5. Safety vests and ASTM-certified headgear must be worn when mounted.
6. $35 per division. Extra round $15. The event’s closing date is the 7th day prior to the event.
Post closing-date entries will be accepted (with an additional fee of $10).
7. Management reserves the right to stop and excuse an unsafe horse/rider combination. Rider
fall will result in elimination and you must leave the course. With the assistance of your
trainer you can school an “extra round”.
8. Dogs must be leashed at all times.
9. A signed liability waiver must accompany each entry.
10. Current coggins & rabies certificates must accompany entry and will be kept on file for
the year.
CLASS LIST
Elementary........................................2’ ......................................@ 300mpm
Beginner Novice ...............................2’7” ..................................@ 325mpm
Novice ................................................2’11” ................................@ 350mpm
HORSE POWER FARM
233 Woodchuck Hill Road
Canterbury, CT 06331
860-334-1772
* www.horsepowerfarm.info *
CROSS COUNTRY DERBY– ENTRY FORM
April 30, June 25, July 30, Oct 15, 2016
Rider: jr/sr (circle one ______________________________________
Please print clearly, I mail ribbons. Thank you!
Mailing Address: ___________________________________________
_________________________________________________________
Phone: _______________ e-mail: ____________________________
Horse: ___________________________________________________
Owner: __________________________________________________
Trainer: __________________________________________________
Division(s): _______________________________________________
$35 per Division. Extra schooling within division $15 (see Event
Secretary). Closing date is the 7th day prior to event. Add $10 for late
entries. Post entries welcome, $10 fee.
Total Enclosed: $___________________
Note: Enclose your signed check, liability waiver, a copy of your
current coggins-rabies certificate, and Emergency Contact
Information.
Liability Waiver
I_________________________________(riders name) hereby agree to release, indemnify and
hold harmless Horse Power Farm, 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 also 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 the competition or related activities.
Date: _______________________
Signature of rider over 18:_______________________________________________
Signature of Parent of rider under 18:______________________________________
Emergency Contact Information
Name: ____________________________________________________________
Relation to rider: ____________________________________________________
Phone: ____________________________________________________________
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