CRESTFIELD FARM SHOW ENTRY FORM

WARNING: Under Arkansas 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 risk of equine activities.

SHOW NAME: Crest Field Farm Show______SHOW DATE: May 22, 2016______

HORSE NAME: ______RIDER/HANDLER______

ADDRESS ______

PHONE ______E-MAIL ______

COGGINS DATE ______

Enter the class number, division and class description for each ride you have selected from the Crestfield Show Class List

Class
Number / Division
(Jr, Am, Open) / Class
Description

(1) Closing date is 04-13-2016. (2) The entry must be post-marked by closing date. (3) This show is not restricted to just ADS members, but only scores earned by ADS Members will count towards ADS awards. (4) Entry fees are refundable before closing date or with a veterinarian certificate before show. (5) A $10 late fee applies to each ride scheduled after closing date. (6) A $5 change fee applies to each change after closing date. (7) Rides may be limited or closed if a show is over subscribed. (8) Grounds fee due for each horse entered, including boarders of Crestfield farm. (9) For overnight stabling, contact the host farm owner. (10) Protective headgear & footgear required at all times while mounted. (11) Please wear neat, conservative attire. (12) Due to insurance restrictions. No Dogs Allowed on the Show Grounds. (13) Original coggins report within 12 months is required to enter the show grounds.


FEES

Class Fee - per class / $15.00
Grounds Fee - required / $15.00 / $15.00
Office Fee - required / $12.00 / $12.00
Stall - optional / $15.00
Total Due

make checks payable to Crestfield Farm

Mail Entries to: Cindi Sammartano

1724 North Tyler Street

Little Rock, AR 72207

Phone: (501) 680-3391

I understand the entries are made at my own risk. The owners accept no responsibility for accidents, damage, and injury

or illness to horses, owners, riders or spectators or to any other person or property in connection with this show.

Signature______parent or guardian must sign for junior riders

revised 04-21-16