Champlain Valley Horse Trials

Sunday, August 26, 2018 at High Wind Farm

Closing Date for entries must be postmarked prior to 8/22/2018

One form per horse and rider please.

Rider's Name:______

Address:______EMAIL______

City:______State:______Zip:______

Phone: ______Cell#______Date of Birth: ______

US Pony Club Member?_____ US Pony Club Name: ______

Horse name on Coggins: ______Breed: ______

Check Event:

3-Phase (dressage, stadium, XC)$75USPC Members / $85 non-USPC

2-Phase(dressage, stadium)$55USPC Members / $70non-USPC

Dressage Only (Tests based on division chosen below. All small arena. Fee per test.)

  • $35 USPC Members / $40 non-USPC

USDF INTRO TEST B AVAILABLE –DRESSAGE ONLY FOR WALK/TROT

Check Division:

Grasshopper: 18”, XCmax 8 jumping efforts,USEF2014 Beginner Novice Test A

Elementary: 2’, XC max 8 jumping efforts, USEF 2014 Beginner Novice Test A

Beginner Novice: 2’ 6”, XC 10-12 jumping efforts, USEF 2014 Beginner Novice Test A

Novice: 2’ 11”, XC 14-16 jumping efforts, USEF 2014 Novice Test A

Novice/Training: Stadium max 3’ 3”, XC max 2’ 11”, 14-16 jumping efforts, USEF 2014 Training A

Entries must include:

  • This completed form. Mail to:Lora Merrill at 382 Lewis Creek Road, Charlotte, Vermont 05445
  • Entry Fee - checks made out to Charlotte Pony Club
  • Copy of Coggins dated within 1 year

No phone entries please. ALL entries received after closing date will be accepted only if time and space permits;Late Entry fee + $20. Make Checks out to Charlotte Pony Club. NO REFUNDS AFTER CLOSING DATE.

All participants are required to wear their medical arm band. XC riders must wear a safety vest. Champlain Valley Horse Trials are run under the rules of the USEA and though the trials are for schooling purposes, all rules will be followed, and any changes will be made only at the discretion of the management. If you are unfamiliar with these rules please visit or

I have enclosed a total of $______for the above entry, which is made at my own risk.I understand that this is a high risk sport. I hereby assume all risk and further do hereby release and hold harmless the Charlotte Pony Club and its officers, organizer, organizing committee, officials and volunteers, the property owners, the USPC or any other persons connected with this event, for negligence resulting in accidents, damage, injury, death or illness to myself and to my property, including the horse which I ride.

______

Signature of Rider Date

______

Signature of Parent or Guardian if rider is under 18 Date

For questions email website charlotteponyclub.com

PHYSICAL ADDRESS OF HIGH WIND FARM FOR GPS LOCATORS: 100 Roscoe Road Monkton, VT.