Annual Southwest Zone Gymkhana
SUNDAY 14th June 2015
Hosted by Capel Horse and Pony club
Address- Capel Regional Equestrian Park
Cnr Goodwood Rd & Capel-Tutunup Rd, Capel
ENTRIES CLOSE: 7th June 2015
CLUB NOMINATION FORM
PLEASE NOTE: Individual entries for the Gymkhana will not be accepted. All entries for the Gymkhana MUST be included on this Club Nomination Form. Monies should be collected by
individual Clubs. Clubs should then forward just one cheque covering all entries made out to the “South West Zone of PCAWA”. It is the responsibility of the individual Club to ensure that
all monies received by them are correct.
Entry fee $25.00 ea.
All Nomination Forms to be forwarded to: Jenni Brown Email: bjenni70@gmail.com
All Monies to be handed to Jenni Brown or Yvonne Rielly prior to riding commencing on Sunday.
CLUB: ____________________________________________________
TOTAL MONEY: ________________
Club Organiser (responsible for coordinating all the clubs helpers so everyone does a job through out the day) _________________________________________________________________________
Please enter information using "Word" software if possible and email to ______________________________ . Mail a copy with cheque made out
“South West Zone of PCAWA”. Please record all riders' date of birth as classes will be organised using this information ie Riders 7yrs. Due to low
numbers of entries some age groups may be combined. Please note, there are no "First Ridden classes". Please nominate heights for Show Jumping.
There will be no “led” jumping/no accompanying adults will be allowed in the jump arenas.
Rider’s Name
Date of
Birth
Lead
Line
Y/N
Horse’s Name
M/Ship
No
Helper’s Name & Number
Hacking
Yes/No
S/Jump
1st Rnd
Height
S/Jump
2nd Rnd
Height
Novelties
Yes/No
1
2
3
4
Signature of Chief Coach or Authorized Club Representation: ________________________________________________________________________
(Please copy this page and number accordingly should you need more spaces.)
Rider’s Name
Date of
Birth
Lead
Line
Y/N
Horse’s Name
M/Ship
No
Helper’s Name & Number
Hacking
Yes/No
S/Jump
1st Rnd
Height
S/Jump
2nd Rnd
Height
Novelties
Yes/No
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Signature of Chief Coach or Authorized Club Representation: ________________________________________________________________________
(Please copy this page and number accordingly should you need more spaces.)
Signature of Chief Coach or Authorized Club Representation: ________________________________________________________________________
(Please copy this page and number accordingly should you need more spaces.)