Birds Hill Sensation
April 29-May 1, 2016Birds Hill Equestrian Center
Rider/Owner Information:if owner is different than rider, please put the same info below on the back of the form for the owner.
Name: / Jr Birth Date:Address: / Telephone:
City/Prov / Postal code:
Email / Cell:
EC # / AHA # / FEI #
PSO#(MHC) / other / AERC #
Horse Entry Information: Saturday
Name: / Date of Birth:Sex: / Colour:
Mileage # / Breed & # / AERC #
EC # / FEI Passport # or ID #
Horse Entry Information:Sunday □same as above
Name: / Date of Birth:Sex: / Colour:
Mileage # / Breed & # / AERC #
EC # / FEI Passport # or ID #
Fee Schedule (see below)
Saturday: 24, 40, 80, 120 km (circle one) / $ / Mail entry to:Spruce Endurance
Box 36, Gr 36, RR#2
Dugald, MB R0E 0K0
Or
Cheques to be made out to:
Spruce Endurance
Or
Paypal to
(use transfer not payment)
Sunday: 24, 40, 80, 120 km (circle one) / $
EC Drug Fee(except Pleasure & FEI) each $3.50 x / $
FEI Drug Fee $45.00 x / $
EC Sports License Fee $30.00 (fill out EC form) / $
AERC optional ($10 /entry, +if not member $7/entry)
Stall rental $20/night ($27 cleaning deposit) / $
Pot Luck if not bringing food $10.00 x / $
Camping $10 per night x / $
Birds Hill Center fees $7/day if not stalled / $
Birds Hill improvement fee $3/entry / $
DRM nonmember day fee / $
DMR membership $25 single, $40 Family / $
Total Entry Fee enclosed / $
Distance / fEI
24 km / 15 mile DRM only / $25
40 km / 25 mile DRM/EC / $49
80 km / 50 mileDRM/EC / $69 / $235
120 km / 75 mileDRM/EC / $99 / $295
80km +2 days / $139 / $365
*An Equine Canada Bronze Sports License is not required for the 24 km pleasure
Waivers
I hereby consent to the entry of my child in this horse show and acknowledge that I have read the front side and the reverse side of this entry form and agree to the applicable terms, conditions, waivers, and consent as set forth herein and accept responsibility hereunder for the participation of said Minor (Junior Rider).
In the event that ______participates in an Equine Canada sanctioned competition where protective headgear is required for juniors, he/she will wear properly fitted and fastened approved headgear at all times while riding or driving at the event location. It is understood that juniors not meeting this requirement will not be allowed to compete at these competitions.”
I hereby certify that every horse, rider and/or driver is eligible as entered and agree for myself and my representatives to be bound by the Constitution and rules of Equine Canada at this competition. It is hereby recognized that all equestrian sports involve inherent risk and that no helmet or protective equipment can protect against all foreseeable injury. I hereby accept this risk and hold harmless EC, the competition, their officials, organizers, agents, employees and their representatives. “The person responsible (PR) agrees to the release of any information on the entry form to EC”
Signature of Person Responsible ______Date:______
Name of the Person Responsible (Print name)______Date: ______
EC #: ______
Section A, General Regulations-Glossary: Person Responsible
The Person Responsible for a horse must be an adult who has, or shares, responsibility for the care, training, custody, and performance of the horse and who has official responsibility for that horse under EC Rules and is liable under the penalty provisions of the Rules for any violation of the EC Rules. For the purpose of these Rules, the Person Responsible is normally the trainer, owner or the competitor who rides or drives the horse during an event, or a parent or legal guardian in the case of junior competitors. The Person Responsible is ultimately responsible for the condition, fitness and management of the horse and is alone responsible for any act performed in the stables by himself or herself or by any other person with authorized access to the horse, or while the horse is being ridden, driven or exercised. The Person Responsible must hold a valid EC Sport License in good standing at the same level or higher in which the horse is competing.
However, when the competitor is a Junior, the competitor cannot be the Person Responsible and the Person Responsible may be a parent/guardian who must be at minimum an EC or USEF member in good standing.
The entry form must list the Person Responsible name, their EC or USEF member number and be signed.
Signature of Rider (or Parent/Guardian if Junior):______Date: ______
Name of Rider (please Print): ______
Signature of Owner: ______Date: ______
Name of Owner (please Print): ______
Emergency Contact Name: ______Phone #: ______
DistanceRidersofManitoba.cafacebook.com/DistanceRidersofManitoba