Gerogery EC - Competition Entry Form

Gerogery Equestrian Club - Competition Entry Form

HRCAV Affiliated Club
Select the Competition you are entering with Gerogery Equestrian *
Rider Name*

First NameLast Name
Rider's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PIC Number of Property Horse is housed at:*
Rider's Email Address*
example@example.com
Rider's Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Club Name:*
Rider Age:*
Rider's HRCAV Membership Number:*
Emergency Contact Name:*
Emergency Contact Mobile Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency contact relationship to rider:*

Competition Date*

MonthDayYear
Date
Horse's Competition Name:*
Horse's Height:*
Horse's Colour:*
Horse's Brands:*
Horse's Sex:*
Level Entering:*
Dressage Level (required for Dressage, CT, HT entries)*
Judge's Name:
I am ineligible to compete under the above mentioned judge as it would be in breach of either Dressage Rule 4.9 or Showing 4.4
Nature of Exemption:
I have been granted a HRCAV rule exemption, copy of the exemption certificate is attached
Exemption Certificate

Cancelof

Registration for camping & stables/yards:

Where the program states that camping and stabling/yarding for overnight stays is on offer please register your details below.

Not often our competition have this option, please take note if the program of the competition you are entering states that this option is on offer before completing.

Where applicable on camping and yarding, all venues always require attendees to clean up after themselves with rubbish and manure. Fires will only be permitted per government guidelines.
Will you be camping:
How many Vehicle/Float Combinations will this entry be paying for:
Total fee paid for camping:
Please refer to the program for the fee per campsite
Will you be requiring a yard:
Please check the program to confirm that there is yards available to be booked
How many yards will this entry be paying for
Total Fee paid booking of yards
Please refer to the program of the competition you are entering for the fee per yard.

Thank you for your entry, you must make the entry payment to the below bank account before your entry will be completed.

Account Name: Gerogery Equestrian Club

BSB: 640-000

Account Number: 111 063 789
I understand and agree to abide the Rules and Regulations of the Horse Ridings Clubs Assosiation of Victoria Inc. and the conditions of the entry as stated on the official program. I understand that due to diseases such as equine influenza, government bodies may restrict or prevent the movement of horses, vehicles and personnel for a period of time ('standstill'). I acknowledge and agree that a standstill is a risk of participationin the event/activity and agree that I will pay any costs or expenses incurred by the organising committee for or on behalf of my horses as a result of a standstill.
Attach copying direct transfer receipt for entry fee

Cancelof
Signature of Rider (or Parent/Guardian if rider is under 18 years):*

Clear
Signature of Rider (or Parent/Guardian if rider is under 18 years):*
Date Signed & Completed*

MonthDayYear
Date
Should be Empty: