CENTER LINE FARM SHOW & CLINIC ENTRY FORM
(print out & mail)

EVENT: ___________________________        DATE:__________

RIDER: _________________________________________________    JR/SR

STREET: ________________________________________________

TOWN: ______________________________________   STATE : ______

ZIP CODE :_____________  PHONE: _____________________________

EMAIL:______________________________________________________

HORSE BREED / AGE / SEX CLASS / DIV ENTRY FEES

HORSE NAME Breed/Age CLASS or TEST ENTRY FEE
      $15
      $15
      $15
      $15
OVCTA  Non-Member Fee  
 (Less)  Activity Certificates:  
TOTAL ENTRY FEE:  

                                                                

 

Entries will only be accepted if complete with signature, full payment of fees and Negative Coggins Test.

I enclose herewith a total of $ ____________ for the aforementioned entry, which is made at my own risk and subject to the conditions of the organizer.

RELEASE: I understand that this is a high risk sport and am participating at my own risk. I hereby release and hold harmless the Organizer, Organizing Committee, judges and officials, the host and property owners from any and all accidents, damages, injury or illness to horses, owners, riders, employees, attendants, spectators, or any other person or property loss suffered during or in connection with this event.
SIGNATURE: _______________________________

(Note: Parent or guardian must sign if competitor is under 18)

Mail to:
Linnea Seaman
Center Line Farm
1281 Pineland Rd.
Birdsboro, PA  19508

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