YHS Entry Form

YHS Entry Form

NC Qualifier at TIEC
Show Date: September 6, 2025 | Closing Date: September 1, 2025

PLEASE FILL OUT THIS FORM THOROUGHLY AND COMPLETELY
Name of Horse*
Gender*
Breed/Registry*
If "Other" Please specify Breed/Registry Here
Date of Birth (enclosed proof)*

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Pedigree Page (optional but helpful if available)

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Link to pedigree (if available)
Sire*
Dam's Sire*
Country of Birth*
Breeder*
Owner*
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
Trainer (if applicable)

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Rider (if applicable)

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
Coggins Date*
Coggins (upload)*

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Health Certificate Date
Health Certificate (upload)

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Discipline of Choice for Year End Awards

HunterJumperEventerDressage
Pony?*

YesNo
For Sale?

YesNo
Asking Price
Sales Contact Name
Sales Contact Phone
Please enter a valid phone number.
Stall*

YesNo
Notes (stabling requests, horse information you would like included in the catalog, etc.)

Classes

Stall/Trailer InStall - per night. Trailer in - per day/per horse

$50.00

	Quantity	Price
Stall		$50.00
Trailer In		$30.00

Grounds Fee

$60.00

Office Fee

$50.00

Schooling

Schooling O/F (Friday)Open to all ages, $20 per round. Available on Friday only. For a warmup round on Saturday please select W403, W404 or W405 from the class list

$20.00

Class #210Schooling/Warm Up Jump Chute. Includes handler fees. Not judges. Ages 1-5. Available on Friday only, not on Saturday.

$55.00

Warm Up

Warmup Class #W403Schooling Cross Rails - O/F - $30/round

$30.00 Quantity

Warmup Class #W404Schooling O/F $30/round (not judged) (0.85m-1.0m)

$30.00 Quantity

Warmup Class #W405Schooling O/F $30/round (not judged) (1.0m-1.10m)

$30.00 Quantity

In Hand/At Liberty

Class #101 (includes handler fees)Yearling In Hand/At Liberty

$75.00

Class #102 (includes handler fees)2 Year Old - In Hand/At Liberty

$75.00

Class #104 (includes handler fees)4 Year Old In Hand/At Liberty

$75.00

Class #103 (includes handler fees)3 Year Old In Hand/At Liberty

$75.00

Jump Chute

Class #202 (includes handler fees)2 Year Old Jump Chute

$75.00

Class #204 (includes handler fees)4 Year Old Jump Chute

$75.00

Class #203 (includes handler fees)3 Year Old Jump Chute

$75.00

Flat Under Saddle

Class #3033 Year Old Flat Under Saddle

$45.00

Class #3044 Year Old Flat Under Saddle

$45.00

Class #3055 Year Old Flat Under Saddle

$45.00

Jumping Under Saddle

Class #4044 Year Old Jumping Under Saddle $35/round

$35.00 QuantityJump Height

Class #4055 Year Old Jumping Under Saddle $35/round

$35.00 QuantityJump Height

Dressage Test of Choice

Class #500Dressage Test of Choice (Open to 4 and 5 Year Olds)

$45.00

Total

$0.00

IMPORTANT: PLEASE READ

I AGREE in consideration for my participation in this Competition to the following:

I AGREE that “Competition” as used herein includes, Sponsor, Competition Management, as well as all of their officials, officers, directors, employees, agents, personnel, volunteers.

I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”).

I AGREE to hold harmless and release the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me
or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Competition.

I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Competition.

I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the competition strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior rider, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition.

© All rights reserved - 2025
I have read and I agree to all the YHS and local farm or grounds rules regulations and to all the rules posted in this show’s prize list and entry form.*

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Date*

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Date
PAYMENT METHODS

We accept:

Venmo: @Megan-Paget-Brown

PayPal: meganpb@mac.com

Please make sure to send your payment when you submit your entry form. Any questions please contact meganpb@mac.com or 434-227-0994. Please indicate in the payment notes the horse name which you would like to apply the payment.
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YHS Entry Form

Show Date: September 6, 2025 | Closing Date: September 1, 2025