SOUTHERN VALES DRESSAGE CLUB INC Closed Unrestricted Competition Sunday 15th February 2015 Tests: Prep A, Prep C | 1.1, 1.2 | 2.1, 2.2 | 3.1, 3.2 | Higher Tests on Request Pony Dressage All Classes Entry Fees: SVDC Members $10.00 Non SVDC Members $20.00 Closing Date: Monday 2nd February 2015 *Sorry, late entries no longer accepted Current SVDC Membership No: If you are not a member of SVDC you must state your level of EA Membership and complete the attached Waiver Current EA Membership No: Type: Competitive Participation Pic number of the property where the horse is located: Stallion? Yes Must be under control at all times or will be asked to leave. Handler must be 18 years of age or over. PLEASE USE ONE ENTRY FORM PER HORSE. MAXIMUM 2 TESTS PER HORSE. *MAXIMUM 3 HORSES PER RIDER. TEST HORSE BRIDLE # SNR ENTRY JNR FEE RIDER $ $ Arena Levy $ 5.00 Admin Levy $ 5.00 *If entering more than 2 horses please nominate here your order of preference in case a ballot is necessary (enter 1, 2, 3) Yard Fee ‐ # of Yards X $5.00 $ 0.00 I have a credit note and wish to apply it -$ Tick here for pony dressage TOTAL AMOUNT PAYABLE $ 10.00 Cheques made payable to Southern Vales Dressage Club – DO NOT SEND CASH Payment by internet banking: A/C Name: Southern Vales Dressage Club Bank: ANZ BSB:015‐627 A/C No: 4862 10576 Attach receipt to entry form PLEASE RETURN TO The Draw Secretary Rai Walla PO Box 464 McLaren Vale SA 5171 Phone: (08) 8383 0109 [email protected] Name: Address: Phone: P/Code Email: Signature:________________________________________________ Parent or guardian to sign if rider is under 18 years of age DOB: (Jnr only) *Competitors entering more than 2 horses are asked to indicate which horse(s) will take priority in the event of a ballot. Whilst all effort will be made by the SVDC Committee to accommodate all entries received, SVDC reserves the right to use a ballot system based on the order preference nominated by the rider on the entry form where more than 2 horses have been entered and are being ridden by the same rider on the day. The ballot system will be used where it is impossible to give reasonable time for the horse/rider combination to warm‐up due to oversubscription or under subscription of entries. In the case of an entry being balloted out, SVDC will return the entry and fully refund all fees paid. Conditions of entry: The competition will be governed by the EA rules for dressage. I have read and accept the complete conditions of entry for this event as detailed in the SVDC website – www.svdc.info. Please note: Due to limited warm‐up areas, only those horses actually competing on the day may be worked on the Park grounds by their nominated rider. The draw will be posted on our website www.svdc.info. If you would like a copy of the draw posted to you, please enclose a stamped self‐addressed envelope. Please complete this form if you are NOT a member of SVDC and return with your Entry Form Member Release Waiver of Liability The Equestrian Federation of Australia and ACN 077 455 755 ABN 19 077 455 755 Full Name of participant (and guardian if under 18 years) Address State Post Code Date of birth / dd / mm yyyy Name of Club/Organisation SOUTHERN VALES DRESSAGE CLUB INC EA Membership No. Address of Event / Activity EQUESTRIAN PARK, PORT ROAD, ALDINGA, SOUTH AUST In consideration for being permitted to participate in any way in horse sport activities, I, the undersigned, understand, acknowledge and accept that: Horse sports are a dangerous recreational activity and horses can act in a sudden and unpredictable (changeable) way, especially if frightened or hurt. There is a significant risk that serious INJURY or DEATH may result from horse sport activities. I knowingly and freely assume all such risks, both known and unknown, and I voluntarily PARTICIPATE at my OWN RISK and assume sole responsibility for any injury, death or property damage I may suffer that arises from my participation in horse sport activities. I understand and acknowledge the dangers associated with the consumption of alcohol or any mind altering drugs before and during the activities and I take full responsibility for any injury, loss or damage associated with their consumption. I agree not to drink alcohol or take drugs prohibited by law before or during any horse sports activities. I agree to follow the directions of any event organiser or official and that any misconduct or refusal by me to follow any direction of any organiser or official can result in the CANCELLATION of my participation in the activities and my immediate removal from my horse NO MATTER where that may occur. I understand that any such non-compliance may result in injury, death and/or permanent disability as a result of my failure to comply. I agree to wear a helmet at all times whilst riding where this is required under the relevant EFA and FEI rules and regulations and agree that I am solely responsible for ensuring that whilst riding I wear a suitable helmet at all times where required under the relevant EFA and FEI rules and regulations and take sole responsibility for my actions. I have had sufficient opportunity to read this assumption of risk agreement, fully understand its terms and sign it freely and voluntarily. Dated: Signature of rider/guardian dd mm yyyy For Participants of Minority Age (Under Age 18) This is to certify that I, as a parent/guardian with legal responsibility for this participant, acknowledge, understand and accept ALL OF THE ABOVE and consent and agree to my minor child's involvement or participation in horse sport activities. Dated: Signature of rider/guardian dd mm yyyy