Entry Form : VHSA/BHSA Associate Horse Show at Fox Pointe Farm LLC Mail, Email or Fax Entries to: Fox Pointe Farm 5205 Wildlife Ridge Trail Quinton, VA 23141 If your Email address has changed or has recently been added, please notify the secretary as soon as possible. Cell: (804) 263-5191 Farm Phone: (804) 932-8710 Email: firstname.lastname@example.org All Information is Required For 2014 Show Date: Mar 29, April 26, May 17,June 21,July 12,Sept 21,Oct 18 (Circle Date) Class Numbers Entered Horse or Pony (L,M,S) Pony (L,M,S) / Horse Owner ALL ENTRIES MUST BE SIGNED BY OWNER / RIDER. PARENT / GUARDIAN MUST SIGN FOR MINORS. Rider Adult / Junior Please complete information below Entry Fees: $35 per Division Or $12 per Class $15 for VHSA Equitation Non-showing Schooling $25. CA warm up $10, ride course B. Cash or Checks *Make Checks Payable to “Fox Pointe Farm” Total Due Amateur/Professional There is no charge if the rider is not able to show. $25 fee for returned checks. Address Trainer Entering a class or schooling at this Show constitutes an agreement that the exhibitor will not hold the Management, Staff or Volunteers of Fox Pointe Farm LLC, or The VHSA responsible for any loss or injury due to intrinsic dangers of equine activities. Owner Signature Rider Signature Print Name Clearly Telephone Number (Required) Parent/Guardian Signature Email Address “Intrinsic dangers of equine activities” means those dangers or conditions that are an integral part of equine activities, including but not limited to, (i) the propensity of equines to behave in ways that may result in injury, harm or death to persons on or around them; (ii) the unpredictability of an equine’s reaction to such things as sounds, sudden movement, and unfamiliar objects, persons, or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals or objects; and (v) the potential of a participant acting in a negligent manner that may contribute to injury to the participant or others, such as failng to maintain control over the equine or not acting within the participant’s ability.