Eastern Hills Horse and Pony Club
Unofficial Dressage Training Event
July 30th 2011
Parkerville Equestrian Centre
Seaborne St, Parkerville
The following tests are offered:
 Prep 2 Walk Trot
 Prelim 1B
 Prelim 1C
 Nov 2B
 Nov 2C
 Elem 3B
 Elem 3C
 Med 4B
 Med 4C
********************
Rosettes to 3rd place Ribbons to 6th place Some prizes
This event will be run under PCAWA rules for dress and gear checking. Please make yourself aware of
the requirements. (ie long sleeves). Pony Club members must wear full pony club uniform. Horses to
be plaited.
No stallions will be allowed at this event as this is a Young Rider Association and we do not have stallion
facilities.
Refunds will not be given after the close of entries without a vet/medical certificate.
COST: 1st Test $25, 2nd test $20, 3rd test $15. Members of EHHPC 1st test $20, 2nd test $15, 3rd test
$10. Each horse may only be entered in 3 tests per day at two consecutive levels. Non PCAWA or EWA
members must pay $10 day membership and complete the PCAWA DISCLAIMER STATEMENT – NON
PCAWA MEMBERS.
Please post the official entry form with cheque (make cheques payable to: Eastern Hills Horse and Pony
Club Inc.) to:
The Event Co-ordinator
530 Oliver St
Mount Helena 6082
or
Email entry with direct payment receipt (BSB 633000 Account number 135970333) to
m_tcrook@bigpond.net.au. If paying by Direct Debit please put reference of DRSG and surname.
Full canteen facilities will be available.
Entries Close cob July 20th
Draw Available July 25th on www.cavalletti.com.au
NO DOGS ALLOWED ON GROUNDS
Eastern Hills Horse and Pony Club
Unofficial Dressage/Training Event
ENTRY FORM
NAME _____________________________________________
AGE (IF UNDER 16______
PONY CLUB _____________________ PCAWA NO. __________ EWA No._________
HORSE
ADDRESS
_______________________________
_________________________________________________________________________
PHONE NO. (A/H or mobile) _________________________
EMAIL _____________________________________________________
CLASSES ENTERING
Each horse may only be entered in 3 tests per day at two consecutive levels
Test
Preparatory 2
Prelim 1:B
Prelim 1:C
Novice 2:B
Novice 2:C
Elementary 3:B
Elementary 3:C
Medium 4:B
Medium 4:C
Payment:
Non EHHPC Members
$25 First Test
S__________
$20 Second Test
$__________
$15 Third Test
$__________
$10 Day Membership
$__________
(non PCAWA or EWA members only)
Tick
EHHPC Members
$20 First Test
$15 Second Test
$10 Third Test
TOTAL AMOUNT PAYABLE
Paid By Cheque ___________________
S__________
$__________
$__________
$ ___________
Paid By Direct Debit Receipt No. ___________________
SIGNED______________________
SIGNATURE OF GUARDIAN IF RIDER UNDER 18____________________
DATE _____________________
Direct Debit to BSB 633000 ACCT 135970333. If paying by Direct Debit please put reference of DRSG
and surname. Cheques payable to Eastern Hills Horse & Pony Club Inc.
ENTRIES TO: THE EVENT CO-ORDINATOR - 530 Oliver St Mount Helena 6082 by cob
Wednesday 20th July 2011 or email to m_tcrook@bigpond.net.au
PONY CLUB ASSOCIATION OF WESTERN AUSTRALIA INC (PCAWA)
DISCLAIMER STATEMENT – NON PCAWA MEMBERS
CLUB NAME:
CLUB ADDRESS:
EASTERN HILLS HORSE AND PONY CLUB
SEABORNE ST, PARKERVILLE
EVENT: Eastern Hills Horse & Pony Club Unofficial Dressage Event
(hereafter referred to as “EVENT”)
I acknowledge and agree as a condition of participating that neither the Club/Coach, participants, PCAWA or
any subdivision thereof, officials, volunteers, medical personnel, any persons, promoters, sponsors, advertisers,
owners and lessees of premises used to conduct the EVENT(S), shall be under any liability for my death or any
bodily injury, loss or damage which may be sustained or incurred by me, as a result of participation in or being
present at the event, except in regard to any rights I may have arising under the Trade Practices Act 1974 (Cth)
(or similar State legislation).
I acknowledge that equestrian activities are dangerous and that accidents causing death, bodily injury, disability
and property damage, can, and do happen.
BY SIGNING HEREUNDER I CONFIRM HAVING READ AND UNDERSTOOD THE CONTENTS OF
THIS DISCLAIMER
..........................................................
...........................................................
Print Name Here Sign Here Dated
PARENT/GUARDIAN CONSENT FOR UNDER 18 YEAR OLD PARTICIPANTS
I,______________________________________________
being the parent/guardian of the
abovenamed, ______________________________ confirm that I have read the whole of this document and
have taken all necessary actions to ensure I am aware of the activity which the abovenamed, will be asked to
participate in and consent to him/her participating. In doing so, I acknowledge that equestrian activities are
dangerous and that accidents causing death, bodily injury, disability and property damage can and do happen.
I agree that neither the club/coach, participants, PCAWA or any subdivision thereof, officials, volunteers,
medical personnel, any persons, promoters, sponsors, advertisers, owners and lessees of premises used to
conduct the EVENT(S) shall be under any liability whatsoever for the death or any bodily injury, loss or damage
which may be suffered or incurred by the abovenamed or by me in or being present at the EVENT(S) except for
any rights the abovenamed or I may have arising under the Trade Practices Act 1974 (Cth) (or similar State
legislation).
BY SIGNING HEREUNDER I CONFIRM HAVING READ AND UNDERSTOOD THE CONTENTS OF
THIS DISCLAIMER
________________________________
_______________________________
NAME (BLOCK LETTERS) SIGNED
DATED THIS ________________________ DAY OF_____________________ 2011