ENTRY FORM128 & Under138cm & Under148cm & Under
Race to be entered:125
(circle as appropriate)3467
Entries close Saturday 19 March. No entries or alterations will be accepted after this date and no entry will be accepted without the DC signature. Cheques payable to Area 9 Pony Racing
RIDER DETAILSPRINT DETAILS CLEARLY
Name: ...... ……………………………………………………………......
Age: ...... Date of birth………………………
Pony Club Branch/Centre: ……………………………………………………………...... Area: ......
PONY DETAILS Name: …………………………………………………………………………………
Age……………Colour…………………...... Height …………......
NOVICE RACES: Has the Rider won a Champion Headwear Hat Voucher before YES / NO
CONTACT DETAILS
Name: ......
Address: ……………………………………………………………………………………………………....
……………………………………………………………………………………………………………….....Post Code …………………………… e mail. ………………………………………………………….....
Telephone / Mobile Number: ………………………………………………......
I confirm that I/we have read a copy of The Pony Club Pony Racing Rules 2016 and that I/we agree to abide by them.
Photographic rights - competitors and their guardians hereby give permission for any photographic and/or film or TV footage taken of persons or horses/ponies taking part in the Pony Club events to be used and published in any media whatsoever for editorial purposes, press information or advertising by or on behalf of The Pony Club and/or official sponsors of The Pony Club.
Signed: ………………………………………………………………………………. Parent/Guardian
Parent/Guardian - please also read and sign the declaration over the page.
QUALIFICATION:
I confirm that ………………………………………………… ………………...... is a Member of the
………………………………………………….………………………...... Branch/Centre of The Pony Club and the Combination of Member and Pony (named above) have participated in
i)a minimum of 2 (ridden) working rallies or
ii)a minimum of 1 passed PRA/PC Training Day
(give date and venue of Training Day) ......
since the 1st July the previous year.
Signed ………………………………………………….....District Commissioner/ Centre Proprietor
Print Name: ………………………………………………………………………………………………..
Do not forget a Photocopy of Vaccination Certificate, a copy of JMB Certificate (if applicable)
2016 Entry/Declaration Form
Entries to be sent to Mrs S Marquand, Cora Cottage, Cutsdean, Cheltenham, Glos GL54 5RX
PARENTS DECLARATION
I confirm that I want my son/daughter (Full name) ………………………………………………
To enter and be permitted to ride his/her pony in the above event ; I confirm on my own behalf and on behalf of my son/daughter that I recognise that riding including riding at speed in company of other children and ponies is an activity with considerable attendant risks. I acknowledge that whilst the organisers of the above event, their officials and employees, will endeavour to reduce risks to those participating they cannot be held responsible for the errors of participants or unexpected animal behaviour.
I accept that it is a condition of entry that the rider will do his/her best to conduct him/herself and to ride his/her pony in such a way as to minimise risk of injury to him/herself and to other riders, their ponies and spectators. I have impressed the need for good and sensible behaviour on my son/daughter and have checked his/her pony, tack and other equipment to ensure that all is in order and that nothing about the pony’s tack or other equipment presents a danger to my son/daughter or to other riders or ponies participating in the race or to the organisers, officials, employees or others watching the race.
I understand riding is a risk sport. I am aware there is risk of injury. In the knowledge of this I confirm that I believe my son/daughter to be a competent Rider who is capable of riding in The Pony Club Race Day and subsequently I am happy for him / her to participate. He / she is in good mental and physical health and I know of no condition that would currently preclude them from riding in Pony Races. I accept and agree to abide by The Pony Club Racing Regulations and confirm that the information provided is correct.
Signed. ……………………………………………………….. ……………… Parent/Legal Guardian
Print Name. ……………………………………………………………………………………………......
Date. …………………………………………………………..
2016 Entry/Declaration Form
Pony Club Race Day
At Cheltenham Racecourse
Branch/Centre Area 9
Commentators Notes
Rider Name: / Rider Silks:Please colour.
Pony name:
Jockey Name:
Non-horsey Interests (e.g. play another sport, sing in a band!)
Any quirky stories about you or your pony! :
Past record of achievement in Pony Club Pony Racing:
2016 Entry/Declaration Form