HorseWell Classic 2024 Entry

HorseWell Classic Entry Form

August 30th- September 1st, 2024
Rider Information
Rider Name*

First NameLast Name
Rider Phone Number*
Please enter a valid phone number.
Rider Email*
example@example.com
Rider Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By entering I agree to abide by all HorseWell Classic rules*

Yes
Horse Information

Horse #1 Registered Name*
PLEASE Provide Registered Names of Horses
Checks Written To:*
W-9 or SS# of payee is required for all checks issued.
SSN of Payee*
Open 4D Incentives (check all that apply)*

Diamond Classic (entry through DC website)Cowboy State Stallion Incentive (Enter online through CS)Lucky 7 Bonus (Enter through L7 Website)Nexus (enter through Nexus Site)None
Following is for Futurity & Derby/Maturity Horses ONLY
Owner Name

First NameLast Name
Owner Phone Number
Please enter a valid phone number.
Owner Email
example@example.com
Owner Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Horse #1 Sire Name
Horse #1 Dam Name
Horse #1 Dam's Sire Name
Horse #1 Year Foaled
Horse #1 Color
Horse #1 Sex
Horse #1 Registration Papers or Age Verification (non-registered horses)

Cancelof

Horse #2 Registered Name
PLEASE Provide Registered Names of Horses
Checks Written To:
W-9 or SS# of payee is required for all checks issued.
SSN of Payee
Open 4D Incentives (check all that apply)

Diamond Classic (enter through DC)Cowboy State Stallion Incentive (enter through CS)Lucky 7 Bonus (Enter through L7)Nexus (Enter through Nexus)None
Following is for Futurity & Derby/Maturity Horses ONLY
Owner Name

First NameLast Name
Owner Phone Number
Please enter a valid phone number.
Owner Email
example@example.com
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Horse #2 Sire Name
Horse #2 Dam Name
Horse #2 Dam's Sire Name
Horse #2 Year Foaled
Horse #2 Color
Horse #2 Sex
Horse #2 Registration Papers or Age Verification (non-registered horses)

Cancelof

Horse #3 Registered Name
PLEASE Provide Registered Names of Horses
Checks Written To:
W-9 or SS# of payee is required for all checks issued.
SSN of Payee
Open 4D Incentives (check all that apply)

Diamond Classic (enter through DC)Cowboy State Stallion Incentive (enter through CS)Lucky 7 Bonus (enter through L7)Nexus (enter through Nexuc)None
Following is for Futurity & Derby/Maturity Horses ONLY
Owner Name

First NameLast Name
Owner Phone Number
Please enter a valid phone number.
Owner Email
example@example.com
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Horse #3 Sire Name
Horse #3 Dam Name
Horse #3 Dam's Sire Name
Horse #3 Year Foaled
Horse #3 Color
Horse #3 Sex
Horse #3 Registration Papers or Age Verification (non-registered horses)

Cancelof

Horse #4 Registered Name
PLEASE Provide Registered Names of Horses
Checks Written To:
W-9 or SS# of payee is required for all checks issued.
SSN of Payee
Open 4D Incentives (check all that apply)

Diamond Classic (enter through DC)Cowboy State Stallion Incentive (enter through CS)Lucky 7 Bonus (enter through L7)Nexus (enter through Nexus)None
Following is for Futurity & Derby/Maturity Horses ONLY
Owner Name

First NameLast Name
Owner Phone Number
Please enter a valid phone number.
Owner Email
example@example.com
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Horse #4 Sire Name
Horse #4 Dam Name
Horse #4 Dam's Sire Name
Horse #4 Year Foaled
Horse #4 Color
Horse #4 Sex
Horse #4 Registration Papers or Age Verification (non-registered horses)

Cancelof

Horse #5 Registered Name
PLEASE Provide Registered Names of Horses
Checks Written To:
W-9 or SS# of payee is required for all checks issued.
SSN of Payee
Open 4D Incentives (check all that apply)

Diamond Classic (enter through DC)Cowboy State Stallion Incentive (enter through CS)Lucky 7 Bonus (enter through L7)Nexus (enter through Nexus)None
Following is for Futurity & Derby/Maturity Horses ONLY
Owner Name

First NameLast Name
Owner Phone Number
Please enter a valid phone number.
Owner Email
example@example.com
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Horse #5 Sire Name
Horse #5 Dam Name
Horse #5 Dam's Sire Name
Horse #5 Year Foaled
Horse #5 Color
Horse #5 Sex
Horse #5 Registration Papers or Age Verification (non-registered horses)

Cancelof

PAYMENTS: Payments are due in full by August 26, 2024. Late Fee of $50

**Futurity open to any horse foaled in 2019 or 2020. Derby open to horses foaled 2016-2019 (5-8 yrs)

My Products*

Late FeeAny Entries after 8/26 have a late fee attached.

$20.00

Horse #1

Futurity (#1)$3,000 added

$300.00

Derby/Maturity (#1)$2,500 Added

$200.00

Friday Warm Up Race

$50.00

Futurity & Derby/Maturity Open Carryover (#1)Carryover Time to Open Sat/Sun

$130.00

Novice Horse Sidepot FridayLTE under $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00

3D Youth Friday Cary Over Will run before Open 4D

$25.00

Open 4D Saturday (#1)$1,500 Added

$65.00

Friday Senior Carryover Will run in Open 4D and carryover time to Senior Sidepot.

$25.00

Novice Horse Sidepot SaturdayLTE less than $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00

3D Youth SaturdayWill run before Open 4D

$25.00

Saturday Senior Carryover55 years and older as of January 1st 2024 $500 added

$25.00

Saturday High Stakes Race 2D$1,000 Added Payout dependent on # of entries

$300.00

Open 4D Sunday (#1)$1,500 Added

$65.00

Novice Horse SundayLTE under $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00

3D Youth Sunday14 yrs and younger as of January 1st 2024 Will Run before Open 4D

$25.00

Sunday Senior Carryover 55yrs and older as of January 1st 2024

$25.00

All Runs Count SidePotCarries all runs from weekend to one 4D

$25.00

Target Saturday/Sunday Sidepot Cash Prize to First Place

$25.00

Horse #2

Futurity (#2)

$300.00

Derby/Maturity (#2)

$200.00

Futurity & Derby/Maturity Open Carryover (#2)Carryover Time to Open Sat/Sun

$130.00

Friday Night Warm Up Race(#2)

$50.00

Friday Novice Horse Carryover (#2)LTE under $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00

3D Youth Friday Carry Over (#2) 14 & under as of Jan. 1st

$25.00 Quantity

Friday Senior Carryover (#2) 55yrs and older as of Jan 1

$25.00 Quantity

Open 4D Saturday (#2)

$65.00 Quantity

3D Youth Saturday (#2) 14yr and younger as of Jan 1

$25.00 Quantity

Saturday Novice Horse Carryover (#2) LTE under $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00

Saturday Senior Carryover (#2) 55yrs and older as of Jan 1

$25.00 Quantity

Saturday High Stakes Race

$300.00 Quantity

Open 4D Sunday (#2)

$65.00 Quantity

3D Youth Sunday (#2) 14 & under as of Jan. 1st

$25.00 Quantity

Sunday Senior Carryover (#2) 55yr and older as of Jan 1

$25.00 Quantity

All Runs Count Sidepot (#2)

$25.00

Novice Horse Sidepot Sunday (#2)LTE less than $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00 Quantity

Target Race (#2) Cash prize to first place

$25.00 Quantity

Target Race (#2) 2Cash prize to first place

$25.00 Quantity

Horse #3

Futurity (#3)

$300.00

Derby/Maturity (#3)

$200.00

Futurity & Derby/Maturity Open Carryover (#3)Carryover Time to Open Sat/Sun

$130.00

Friday Warm Up Race (#3)

$50.00 Quantity

Friday Senior Carryover (#3) 55yr and over as of Jan 1

$25.00

Friday Novice Horse Sidepot (#3) LTE $1,000 and under

$25.00

3D Youth Friday Carry Over (#3) 14yrs or under as of Jan 1

$25.00 Quantity

Target Race (#3) Saturday/Sunday

$25.00

All Runs Count Sidepot (#3)

$25.00

Open 4D Saturday (#3)

$65.00 Quantity

3D Youth Saturday (#3) 14yr or under as of Jan 1

$25.00

Saturday Senior Carryover (#3) 55yr and over as of Jan 1 $500 Added

$25.00

Saturday Novice Horse Sidepot (#3) LTE $1,000 and under

$25.00

Open 4D Sunday (#3)

$65.00 Quantity

3D Youth Sunday (#3) 14 & under as of Jan. 1st

$25.00 Quantity

Novice Horse Sidepot Sunday (#3)LTE less than $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00 Quantity

Sunday Senior Carryover (#3) 55yr and over as of Jan 1

$25.00

Saturday High Stakes Race (#3)

$300.00 Quantity

Horse #4

All Runs Count Sidepot (#4)

$50.00

Futurity (#4)

$300.00

Derby/Maturity (#4)

$200.00

Futurity & Derby/Maturity Open Carryover (#4) Carryover Time to Open Sat/Sun

$130.00

3D Youth Friday Carry Over (#4) 14 & under as of Jan. 1st

$25.00 Quantity

3D Youth Saturday (#4) 14 & under as of Jan. 1st

$25.00 Quantity

3D Youth Sunday (#4) 14yrs and under as of Jan 1

$25.00 Quantity

Friday Warm Up Race (#4)

$50.00 Quantity

Open 4D Saturday (#4)

$65.00 Quantity

Open 4D Sunday (#4)

$65.00 Quantity

Friday Novice Horse Sidepot (#4) Horses must have won $1,000 or less. Must run in Open 4D to run in Sidepot

$25.00

Saturday Novice Horse Sidepot (#4) Horses must have won $1,000 or less. Must run in Open 4D to run in Sidepot

$25.00

Sunday Novice Horse Sidepot (#4) Horses must have won $1,000 or less. Must run in Open 4D to run in Sidepot

$25.00

Friday Senior Carryover (#4) 55yrs and older as of Jan 1

$25.00 Quantity

Saturday Senior Carryover (#4) 55yrs and older as of Jan 1 $500 Added

$25.00 Quantity

Sunday Senior Carryover (#4) 55yrs and older as of Jan 1

$25.00 Quantity

Saturday High Stakes Race 2D (#4)

$300.00 Quantity

Target Race (#4) Cash Prize to winner

$25.00 Quantity

Horse #5

All Runs Count Sidepot (#5)

$25.00

Futurity (#5)

$300.00

Derby/Maturity (#5)

$200.00

Futurity & Derby/Maturity Open Carryover (#5) Carryover Time to Open Sat/Sun

$130.00

3D Youth Friday Carry Over (#5) 14yrs and younger as of Jan 1

$25.00

3D Youth Saturday (#5) 14 & under as of Jan. 1st

$25.00 Quantity

3D Youth Sunday (#5) 14 & under as of Jan. 1st

$25.00 Quantity

Friday Night Warm Up Race (#5)

$50.00 Quantity

Open 4D Saturday (#5)

$65.00 Quantity

Open 4D Sunday (#5)

$65.00 Quantity

Friday Novice Horse Sidepot (#5)LTE less than $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00 Quantity

Saturday Novice Horse Sidepot (#5) LTE less than $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00 Quantity

Sunday Novice Horse Sidepot (#5) LTE less than $1,000 Must run in open to be eligible for sidepot Futurity & Derby/Mat horses not eligible

$25.00 Quantity

Friday Senior (#5) 55yrs and over as of Jan 1

$25.00 Quantity

Saturday Senior (#5) 55yrs and over as of Jan 1 $500 Added

$25.00 Quantity

Sunday Senior Carryover (#5) 55yrs and over as of Jan 1

$25.00 Quantity

Saturday High Stakes Race 2D(#5)

$300.00 Quantity

Target Race (#5) Saturday and Sunday

$25.00 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

Should be Empty:

HorseWell Classic Entry Form

Rider Information

Horse Information

Following is for Futurity & Derby/Maturity Horses ONLY

Following is for Futurity & Derby/Maturity Horses ONLY

Following is for Futurity & Derby/Maturity Horses ONLY

Following is for Futurity & Derby/Maturity Horses ONLY

Following is for Futurity & Derby/Maturity Horses ONLY

Credit Card