SATURDAY ENTRY FORM

Show Date:*

Date

NAME*

First NameLast Name

Date of Birth*

MonthDayYear

CGA Membership*

If new, Type NEW. If you have not received a membership number, Type PENDING. CGA Membership is required, you can become a member the day of the show.

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Camping Fee:*

Yes $20/ WEEKENDNo

***Parking/Camping Spots are limited so please be courteous and only use the spots you need. Each Parking/Camping Space is 20ft W x 60ft L to accomodate both truck, trailer and stalls. There is additional space for additional stalls outside of your camping spot for the extra horses if needed.***

Camping/Parking Spots (Required To Fill Out)

Stall Fee*

Friday Night ($20/Night)Saturday Night ($20/Night)Friday & Saturday ($40/Weekend)No Stall Needed

Stall Available

Mount Name:*

Mount Type:*

Division:*

Show Type:*

Events*

Number Of Events Entered*

Jackpot

Mystery Jackpot $5Barrels Jackpot $5

Arena Fee*

Saturday $15.00

Additional Options (Additional Forms Required):

CGA Membership (Single $30/yr)CGA Membership (Family $60/yr)

TOTAL*

***MANDATORY Grounds Fee $15.00 per horse PER DAY***

(Regular events - eligible for ribbons and high points. Times sent to CGA State Office)

(Points event - eligible for daily high point but NO ribbons. Times sent to CGA State Office)

(Time Only events - no ribbons or highpoint, times sent to CGA State Office)

Lead Line - ribbons and prizes given to all patricipants. Times sent to CGA State Office)

***RELEASE OF LIABILITY: The California Gymkhana Association and cosponsoring organization, if any, will not be responsible for any accident that may occur to be caused by any equine competing at any show or for any article of any kind or nature that may be lost or destroyed or in any way damaged. Each competitor will be responsible for any injury that may be occasioned to any person or animal or damage to any property while on the grounds by any equine owned, or in his custody, control and shall indemnify and hold harmless the California Gymkhana Association, it's officials and directors individually and collectively and cosponsoring organization, clubs and arena owners, if any, from and against all charges and expenses of every kind and nature whatsoever arising out of or which may be incurred by reason of any accident, injury, or damage to person or property caused by the ownership, competition or custody or control of any animal competition, In signing this release, please bear in mind that Gymkhana is a contest of speed, that there is a certain element of danger involved and that you will be riding at your own risk. CGA requests that it’s members wear approved safety helmets. If you choose not to wear a safety helmet, then you as an adult rider will accept full responsibility for yourself for any injury which may result from that act when riding in any CGA sanctioned show. Effective March 1, 2003. ALL riders under 18 are REQUIRED to wear a helmet when riding at a CGA sanctioned show. CGA DOES NOT PROVIDE MEDICAL INSURANCE FOR IT’S MEMBERS!

MUST BE SIGNED!!

I UNDERSTAND ALL THE ABOVE

Name*

First NameLast Name

Signature*

Date*

MonthDayYear

DEUCES WILD