Pacific Barrel Horse Association

Entry Form

                                                                                                            BRN4D #______________

Name_____________________________________________________                       CWP # ______________

                                                                                                                               NW5D # ______________         

Address________________________City___________St_______Zip__________

 

Phone____________________email____________________________________SSI Number_______________________

                                                                                                                                

1st Horse_______________________ 2nd Horse________________________

Class

 

 

Open Barrels

$15.00

$15.00

Sidepot

$25.00

$25.00

BRN4D qualifying fee

$2.00

$2.00

CWP

$1.00

$1.00

NW5D

$2.00

$2.00

Youth Barrels (18 & under)

$7.00        Roll             Run

$7.00        Roll             Run

BRN4D Youth qualifying fee

$2.00

$2.00

CWP

$1.00

$1.00

NW5D

$2.00

$2.00

Senior Barrels (45 & over)

$7.00       Roll               Run

$7.00       Roll               Run

BRN4D Senior qualifying fee

$2.00

$2.00

CWP

$1.00

$1.00

Buckaroo Barrels

$2.00

$2.00

Medals Class

$10.00      Roll              Run

$10.00      Roll              Run

Open Poles

$7.00

$7.00

Buckaroo Poles

$2.00

$2.00

Membership

$20.00

$20.00

Family Membership

$30.00

$30.00

Award fee per horse

$20.00

$20.00

Time Runs (1 time)

$3.00 (Buy at the gate please)

$3.00 (Buy at the gate please)

Stalls

$15.00  Trails & Stewarts

$15.00   Trails & Stewarts

RV Hook ups

$15.00    Trails only

$15.00    Trails only

Office Charge

Additional  Horse fee

$7.00

$5.00 per horse

$7.00

$5.00 per horse

 

Total

Total

 

 

 


I do hereby declare that I am a participant or legal custodial parent of guardian of my child or ward participating in this event. I hereby agree to comply with all rules and regulations of the arena, producers and sponsors. For myself, my executors, heirs, next of kin, administrators, successors and assigns, I hereby waive and release all claims that I may have against the Pacific Barrel Horse Association and co-sanctioning organizations, it’s officers, members, volunteers, sponsors, facility owners including any and all claims for damage caused by negligence of any of them, arising out of my participation in this event and it’s related activities. I further agree to indemnify, release, hold harmless and defend the Pacific Barrel Horse Association and co-sanctioning organizations, its officers, volunteers, sponsors and arena owners against any and all claims of injury or damage to persons or property.  I understand that horses and activities involving horses can cause serious injury or death. I hereby acknowledge that participation in this event carries potential hazard, I therefore release the Pacific Barrel Horse Association and co-sanctioning organizations, its officers, members, volunteers, sponsors and facility owners of any liability resulting from injury or death during this event or related activity. This release is perpetual for the 2009 season ending 12/31/09.

 

Signed______________________________________________________Date_______________________

                (Any one under 18 must have a parent or legal guardian sign)

 

Signature of Parent or legal guardian______________________________Date_______________________