CVHS Entry Form –September 8 & 9, 2018

One form per horse/rider combination.

Pre-entries must be received byTuesday, September 4th

EQUINE NAME / breed / AGE / SEX - S/M/G
EXHIBITOR NAME / CVHS MEMBER? YES / NO / DIVISION / AGE AS OF 1/1/18
EMAIL / PHONE NUMBER

CVHS Member/Non Member Fee – Regular Classes $12/$14 Championship Classes $14/$16Pee Wee/Leadline $8/$10

SAVE $35Weekend Package 1 – includes 10 classes (regular or championship), one stall, and office/EMT fees. Member/Non Member$160/$180

SAVE $40 Weekend Package 2 – includes 15 classes (regular or championship), one stall, and office/EMT fees. Member/Non Member$220/$250

Packages do not include post entry fees, additional classes/stalls, shavings, campers, stall cleaning, raffle tickets, or membership fees.

WRITE REGULAR CLASS NUMBERS IN BOXES BELOW: CHAMPIONSHIP CLASS NUMBERS:

TOTAL CLASS FEES / PACKAGE FEE / $ / REQUIRED WITH ENTRY:
COPY OF Rabies Vaccination & Coggins Test
COPY OF Registration Papers (if entering breed classes)
COPY OF CVHS membership card (for discounted fees)
SIGNATURE of Exhibitor/Parent below
Payment via cash, check,credit/debit card, or PayPal.
Check #______Cash______
Credit/Debit Card # (AE ~ VI ~ MC ~ DI)
Exp Date CVC # Billing Zip Code
Mail Entries To:
Shelly Edson, PO Box 974, Middlebury, VT 05753
802-363-1997
Or enter online at
NO ARRIVALS BEFORE 3 P.M. FRIDAY
STALL FEE - $25 per day (one stall included in packages) / $
# needed Friday night/Saturday day: ______Saturday night/Sunday day:______
Stall With:
Stall Next To:
STALL CLEANING FEE –(optional) $10 per stall / $
CAMPER FEE –(optional) - Attach camping request form. / $
SHAVINGS - (optional) $8 per bag PRE-ORDERED ONLY!! / $
RAFFLE TICKETS – (optional) $20 each or 3 for $50 / $
CVHS MEMBERSHIP – (optional) Attach membership application / $
POST ENTRY FEE - $15 per entry (if entered after postmark date) / $
OFFICE FEE – $5 per dayper horse (included in packages) / $
EMT FEE - $5 per day per exhibitor (included in packages) / $
TOTAL FEES – Make checks payable to CVHS
Payment required to process entry. / $

In consideration of the Champlain Valley Horse Shows allowing my participation in this event, I, on behalf of myself, and my heirs, administrators, personal representatives, assigns and children and spouse, if any, do hereby agree to hold harmless, release and discharge Champlain Valley Horse Shows (CVHS) and Addison County Field Days(ACFD), which includes its officers, directors, members, agents, representatives, affiliates and insurers, of and from all claims, demands, causes of action and legal liability whether known or unknown, anticipated or unanticipated, due to the ordinary negligence of CVHS or ACFD. I shall not bring any claims, demands, legal actions or causes of action against CVHS orACFD for any damage or loss due to bodily injury, death or property damage arising out of my participation in this event. Photos taken at CVHS Shows may be used for promotional purposes. Under Vermont Law, an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities that are obvious and necessary, pursuant to 12 V.S.A. § 1039. If paying via Credit/Debit card, your signature below authorizes CVHS to charge the card listed on the entry form for all relevant show fees. exhibitor signature (parent/guardian must sign if exhibitor is 18 and under)

Exhibitor/Parent Signature / Date