2025 Midsouth Region Spring Show Jumping Rally
Nashville, TN ; May 17-18th
Club or Riding Center Name and Team Name (ex. MTPC Team 1):
Rider #1 Name:
Rider #1 Pony Club Participation Age:
Rider #1 HM Certification Level:
Rider #1 Riding Certification Level and Discipline:
Rider #1 Division:
.75
.85
.95
1.05
1.15
.65, non-qualifying
.70, non-qualifying
Rider #1 Horse Name
Height of Mount for Rider #1
Rider #1 Coggins Test:
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Rider #2 Name
Rider #2 Pony Club Participation Age:
Rider #2 HM Certification Level:
Rider #2 Riding Certification Level and Discipline:
Rider #2 Division:
.75
.85
.95
1.05
1.15
.65, non-qualifying
.70, non-qualifying
Rider #2 Horse's Name:
Height of Mount for Rider #2
Rider #2 Coggins Test
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Rider #3 Name:
Rider #3 Pony Club Participation Age:
Rider #3 HM Certification Level:
Rider #3 Riding Certification Level and Discipline:
Rider #3 Division:
.75
.85
.95
1.05
1.15
.65, non-qualifying
.70, non-qualifying
Rider #3 Horse's Name:
Height of Mount for Rider #3
Rider #3 Coggins Test:
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Rider #4 Name:
Rider #4 Pony Club Participation Age:
Rider #4 HM Certification Level:
Rider #4 Riding Certification Level and Discipline:
Rider #4 Division:
.75
.85
.95
1.05
1.15
.65, non-qualifying
.70, non- qualifying
Rider #4 Horse's Name:
Height of Mount for Rider #4
Rider #4 Coggins Test:
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Stable Manager Name:
Stable Manager Pony Club Participation Age:
Stable Manager HM Certification Level:
Who is the Team Captain?
Chaperone's Name:
Chaperone's Email (chaperone forms should be emailed to secretary)
email form to: middletennesseeponyclub@gmail.com
Chaperone phone number:
Coach's name: (coaching form should be emailed to secretary)
email form to: middletennesseeponyclub@gmail.com
Coach's email:
Coach's phone number:
Volunteer #1 Name:
Volunteer #1 Email:
Volunteer #1 phone number:
Volunteer #2 Name:
Volunteer #2 Email:
Volunteer #2 phone number:
DC/RCA Name: As the DC/RCA, I certify that all competitors are Members in Good Standing; National and Regional dues are paid.
DC/RCA Email:
DC/RCA Phone Number:
If other than DC/RCA is the contact for questions about this team please list them here. Name:
If other than DC/RCA is the contact for questions about this team please list them here. Email:
If other than DC/RCA is the contact for questions about this team please list them here. Phone:
Total being sent for entries: $185 per rider, no charge for stable managers.
Write club/center check to "MTPC" and send to: "Jessica Jenkins, secretary, 6228 Wild Heron Way, College Grove, TN 37046"
Submit
Should be Empty: