West Taieri Pony Club SJ Practice Days - 18th August & 1st September 2024

Date (please select both if you intend to attend both)

Rider Name

First NameLast Name

Guardian Name (if under 18)

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Horse 1 Name

Horse 2 Name

NZPCA Financial Member (if no, you will need to sign a casual membership form on the day)

Maximum 3 rounds per horse. If you are riding 2 horses please select 2 heights for each round

Jumping Round 1

Jumping Round 2

Notes/additional info

Jumping Round 3

Please make payment to WTPC 03-1725-0061059-00. Unpaid entries will not be accepted - NO EXCEPTIONS

Please note payment is per day, please double your payment if you are entering both days.

Disclosure Statement

Declaration (to be agreed to if 18 years or over)

I acknowledge and agree that I do not have any medical conditions which may impact upon my participation in this event or if I do, I have disclosed them to the Event Secretary I acknowledge that I agree to be bound by the NZPCA Constitution, Regulations and Policies throughout the duration of the event;

I agree not to hold the Organising Committee or NZPCA liable for any claims, losses, expenses and costs (including legal fees) arising from participation in this event; I agree that I am the Person Responsible for any horse that I ride during this event.

Declaration (to be agreed to if competitor is under 18 years)

I am the parent/guardian/caregiver of the above competitor and I acknowledge that I am the Person Responsible for the horse/pony; I acknowledge that I am responsible for ensuring the fitness of the horse/pony to participate in this event, and for any act performed to the horse/pony while present at the grounds for this event; I acknowledge that I am bound by the NZPCA Constitution, Regulations and Policies while I am the Person Responsible for the horse/pony.

I agree to the above declaration

I acknowledge yellow tag helmets and approved footwear to be worn at all times when riding.

Secretary - Amy McDonald - amy_mcdonald@hotmail.co.nz, 0273801133

West Taieri Pony Club SJ Practice Days - 18th August & 1st September 2024

Schedule