2019 AQHA CENTRAL LEVEL 1 CHAMPIONSHIP SHOW ENTRY

Transcription

1 2019 AQHA CENTRAL LEVEL 1 CHAMPIONSHIP SHOW ENTRY Entries must be received by March 15, 2019 Mail entries to: AQHA Attn: Heidi Lane, Central Level 1 Championship, 1600 Quarter Horse Dr., Amarillo, TX Fax: , hlane@aqha.org, phone: Please include: 2018 Level 1 eligibility print-out Rookie eligibility print-out Copy of horse registration papers and current exhibitor membership card Signed Release of Liability and Indemnity Agreement Multiple checks, money orders or credit cards will be accepted as payment for entry and stall fees HORSE INFORMATION Registered Name Registration # Gender (circle one) Mare Gelding Year Foaled OWNER INFORMATION Owner Name AQHA # Mailing Address City, State, Zip Address Contact Phone Number EXHIBITOR INFORMATION ONE ENTRY FORM PER HORSE/EXHIBITOR COMBINATION Exhibitor Name AQHA # Exp D.O.B Mailing Address City, State, Zip Address Contact Phone Number

2 YOU MUST MARK ALL CLASSES YOU INTEND TO ENTER. YOU MAY SCRATCH CLASSES AT THE SHOW (no refund); Please completely blacken the CLASS circle of every class in which you want to enter. If you want to enter the jackpot, you must also blacken the JACKPOT circle for that class. See the competitor s handbook for Jackpot information. Competitor Resources Class: Jackpot: AMATEUR CLASSES 2018 Eligibility 105 AMA RANCH RIDING- Level AMA SELECT RANCH RIDING- Level AMA REINING - Level AMA WORKING HUNTER - Level AMA EQUITATION OVER FENCES - Level AMA HUNTER HACK - Level AMA BARREL RACING - Level AMA POLE BENDING - Level AMA STAKE RACE - Level AMA HUNTER UNDER SADDLE - Level AMA SELECT HUNTER UNDER SADDLE - Level AMA HUNT SEAT EQUITATION - LEVEL AMA SELECT HUNT SEAT EQUITATION Level AMA SHOWMANSHIP AT HALTER - Level AMA SELECT SHOWMANSHIP AT HALTER- Level AMA PERFORMANCE HALTER MARES - Level AMA PERFORMANCE HALTER GELDINGS Level 1 Class: Jackpot: AMATEUR CLASSES 2018 Eligibility 323 AMA YEARLING MARES - Level AMA TWO-YEAR-OLD MARES - Level AMA THREE-YEAR-OLD MARES Level AMA AGED MARES - Level AMA YEARLING GELDINGS - Level AMA TWO-YEAR-OLD GELDINGS Level AMA THREE-YEAR-OLD GELDINGS Level AMA AGED GELDINGS Level AMA WESTERN RIDING - Level AMA SELECT WESTERN RIDING Level AMA WESTERN PLEASURE - Level AMA SELECT WESTERN PLEASURE - Level AMA WESTERN HORSEMANSHIP - Level AMA SELECT WESTERN HORSEMANSHIP - Level AMA TRAIL - Level AMA SELECT TRAIL Level 1 Class: Jackpot: YOUTH CLASSES 2018 Eligibility Class: Jackpot: YOUTH CLASSES 2018 Eligibility The age of the youth as of January 1 will be the age maintained the entire year (regardless of the day the youth is born). 101 YT RANCH RIDING- LEVEL YT AGED GELDINGS Level YT REINING - Level YT THREE-YEAR-OLD GELDINGS Level YT WORKING HUNTER - Level YT TWO-YEAR-OLD GELDINGS Level YT EQUITATION OVER FENCES - Level YT YEARLING GELDINGS - Level YT HUNTER HACK - Level YT PERFORMANCE HALTER MARES - Level YT BARREL RACING - Level YT PERFORMANCE HALTER GELDINGS - Level YT POLE BENDING - Level YT SHOWMANSHIP AT HALTER Level YT STAKE RACE - Level YT SHOWMANSHIP AT HALTER 13 & U - Level YT HUNTER UNDER SADDLE Level YT WESTERN RIDING Level YT HUNTER UNDER SADDLE 13 & U - Level YT WESTERN RIDING 13 & UNDER - Level YT HUNT SEAT EQUITATION Level YT TRAIL Level YT HUNT SEAT EQUITATION 13 & U - Level YT TRAIL 13 & UNDER Level YT AGED MARES - Level YT WESTERN PLEASURE Level YT THREE-YEAR-OLD MARES Level YT WESTERN PLEASURE 13 & UNDER - Level YT TWO-YEAR-OLD MARES - Level YT WESTERN HORSEMANSHIP Level YT YEARLING MARES - Level YT WESTERN HORSEMANSHIP 13 & U - Level 1 Class: Jackpot: WALK/TROT AMATEUR 2018 Eligibility 201 AMA WALK/TROT HUNTER UNDER SADDLE 204 AMA WALK/TROT HUNT SEAT EQUITATION 400 AMA WALK/TROT WESTERN PLEASURE 404 AMA WALK/TROT WESTERN HORSEMANSHIP 535 AMA WALK/TROT TRAIL Class: Jackpot: ROOKIE AMATEUR CLASSES 2019 Eligibility 104 ROOKIE AMA RANCH RIDING 107 ROOKIE AMA REINING 122 ROOKIE AMA WORKING HUNTER 126 ROOKIE AMA EQUITATION OVER FENCES 130 ROOKIE AMA HUNTER HACK 202 ROOKIE AMA HUNTER UNDER SADDLE 205 ROOKIE AMA HUNT SEAT EQUITATION 338 ROOKIE AMA SHOWMANSHIP AT HALTER 332 ROOKIE AMA WESTERN RIDING 401 ROOKIE AMA WESTERN PLEASURE 405 ROOKIE AMA WESTERN HORSEMANSHIP 536 ROOKIE AMA TRAIL Class: Jackpot: WALK/TROT YOUTH 2018 Eligibility 220 YT WALK/TROT HUNTER UNDER SADDLE 224 YT WALK/TROT HUNT SEAT EQUITATION 435 YT WALK/TROT TRAIL 428 YT WALK/TROT WESTERN PLEASURE 500 YT WALK/TROT WESTERN HORSEMANSHIP Class: Jackpot: ROOKIE YOUTH CLASSES 2019 Eligibility 100 ROOKIE YOUTH RANCH RIDING 102 ROOKIE YOUTH REINING 120 ROOKIE YOUTH WORKING HUNTER 124 ROOKIE YOUTH EQUITATION OVER FENCES 128 ROOKIE YOUTH HUNTER HACK 221 ROOKIE YOUTH HUNTER UNDER SADDLE 225 ROOKIE YOUTH HUNT SEAT EQUITATION 337 ROOKIE YOUTH SHOWMANSHIP AT HALTER 312 ROOKIE YOUTH WESTERN RIDING 436 ROOKIE YOUTH TRAIL 427 ROOKIE YOUTH WESTERN PLEASURE 501 ROOKIE YOUTH HORSEMANSHIP

3 2019 CENTRAL CHAMPIONSHIP STALLING RESERVATION FORM Name on stall block (trainer, barn name, person stalling with) (If you do not list a person to stall with, we will stall you on your own) Registered Name of horses entered Exhibitor(s) for each horse Other People to be stalled in your group Please Check this box if you are attending the OK Spring Show STALLING INFORMATION Earliest arrival: Tuesday, April 9 th at 8am Latest Departure: Sunday, April 14 th by 9am Special notes or requests:

4 2019 AQHA CENTRAL LEVEL 1 CHAMPIONSHIP PAYMENT STALL X $130 = $ EXTRA STALLS (Tack and Horses NOT entered) X $130 = $ PLEASE ADVISE THE PERSON WITH WHOM THIS STALL(S) WILL BE WITH LEVEL 1 CLASSES ENTERED X $65 = $ ROOKIE and WALK/TROT CLASSES ENTERED X $55 = $ JACKPOT CLASSES ENTERED (100% paid back, mailed after the show) X $50 = $ DRUG FEE (PER HORSE) X $35 = $ OFFICE FEE (PER HORSE/EXHIBITOR) 1 X $35 = $ TRAIL OBSTACLE (PER CLASS) X $10 = $ OVER FENCE FEE (PER CLASS) X $10 = $ TOTAL FEES $ LATE FEE POLICY Entries received after deadline date (March 15, 2019) and up to 2 weeks prior to the show s start date: o $150 flat late fee per horse/rider combination plus normal entry fees, drug and office charges Until noon the day prior to the class, only for horse/rider combinations already entered in the show: o Double the class entry fee ($130 for Level 1 classes; $110 for Rookie and Walk Trot classes) Checks must be made to AQHA. Send all paperwork with this form, along with payment, for receipt no later than MARCH 15, 2019 to: Mail entries to: AQHA Attn: Heidi Lane, Central Level 1 Championship, 1600 Quarter Horse Dr., Amarillo, TX Fax: , hlane@aqha.org, phone: PAYMENT TYPE: Check Money Order American Express MasterCard Visa Card Number: / / / EXP: / CVV: Cardholder Name: Phone # of Cardholder: Cardholder Address: City / State / Zip: Signature:

5 AQHA LEVEL 1 CHAMPIONSHIP SHOW ASSUMPTION OF RISK, RELEASE OF LIABILITY AND INDEMNITY AGREEMENT (PARTICIPANT MUST SIGN) As a condition of participation in the AQHA Level 1 Championship Show ( L1CS ), and in consideration of being allowed to participate, the Participant does hereby: 1. ACKNOWLEDGE receipt of AQHA Level 1 Championship Show Rules & Regulations Handbook and the AQHA Official Handbook of Rules & Regulations (collectively AQHA Rules & Regulations ). 2. CERTIFY that I have read, understand and agree to obey (a) all AQHA Rules & Regulations (including, but not limited to, Rule SHW225 (Amateur Eligibility); Rule SHW235 (Youth Eligibility); Rules VIO100, VIO200, VIO300 & VIO330 (Violations); and Rule GEN111 (Likeness Reproduction). I further agree to obey the directions of the AQHA representatives conducting the L1CS. 3. ACKNOWLEDGE, agree, and represent that Participant understands the nature of the participation and attendance activities associated with the L1CS ( Activities ) and that the Participant is qualified, in good health, and in proper physical condition to participate in such Activities; 4. FULLY UNDERSTAND THAT THE ACTIVITIES INCLUDE, BUT ARE NOT LIMITED TO, INHERENT RISKS OF EQUINE ACTIVITIES THAT MAY RESULT IN PROPERTY DAMAGE AND BODILY INJURY, INCLUDING, BUT NOT LIMITED TO, PERMANENT DISABILITY, PARALYSIS, AND DEATH (collectively RISKS ); that such RISKS may be caused by Participant s own action or inaction, the action or inaction of others participating in the Activities, the condition of the premises at which the Activities take place, and/or THE NEGLIGENCE OF THE RELEASEES NAMED BELOW; 5. UNDERSTAND AND AGREE that Inherent risks of equine activities means dangers or conditions that are an integral part of equine activities, including, but not limited to, any of the following: (a) the propensity of a horse to behave in ways that may result in injury, death, or loss to persons on or around the horse; (b) the unpredictability of a horse s reaction to sounds, sudden movement, unfamiliar objects, persons, or other animals; (c) hazards, including, but not limited to, surface or subsurface conditions; (d) a collision with another horse, another animal, a person, or an object; and (e) the potential of an equine activity participant to act in a negligent manner that may contribute to injury, death, or loss to the person of the participant or to other persons, including but not limited to, failing to maintain control over a horse or failing to act within the ability of the participant; 6. FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES PARTICIPANT INCURS AS A RESULT OF PARTICIPANT S PARTICIPATION IN THE ACTIVITIES; 7. WARRANT AND REPRESENT that, if the Activities involve horses, Participant is adequately qualified and experienced to both (a) safely handle and ride a horse in a manner to protect Participant and other third parties, and (b) participate with groups of riders and horses, such as to take adequate defensive action to avoid injury from third party participants and horses. Furthermore, Participant understands that it is Participant s responsibility to ascertain the adequacy of Participant s training and experience, the adequacy and training of Participant s horse, and for Participant to conduct himself/herself in a manner such as to make the Activities safe and enjoyable for all participants; 8. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE AQHA, AQHF, AND/OR AQHA CORPORATE PARTNERS OR THEIR RESPECTIVE ADMINISTRATORS, DIRECTORS, AGENTS, OFFICERS, MEMBERS, VOLUNTEERS, AND EMPLOYEES, AND, IF APPLICABLE, OWNER AND LESSORS OF PREMISES ON WHICH THE ACTIVITIES TAKE PLACE, (EACH CONSIDERED ONE OF THE RELEASEES HEREIN) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES WHENEVER OR HOWEVER ARISING AS TO INJURY, DEATH AND/OR PROPERTY DAMAGE OCCURRING AS A RESULT OF PARTICIPANT S PARTICIPATION IN THE ACTIVITIES OR CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. 9. AGREE to indemnify, hold harmless and defend RELEASEES from any and all liability, whenever or however arising, from all third party claims, demands, causes of action, suits, judgments, liabilities, costs and expenses of any nature arising out of (i) Participant s negligent act(s) or omission(s) during or related in any way to the Activities; and/or (ii) Participant s willful act(s) or omission(s) during or related in any way to the Activities; and/or (iii) any misinformation or misrepresentations made by Participant in this Agreement. Participant agrees to pay any of RELEASEES costs, expenses and reasonable attorney fees incurred, arising directly or indirectly out of or with respect to any third party claims or associated with the enforcement of the indemnity obligations referenced above. 10. AGREE that this Assumption of Risk/Release of Liability/Indemnity Agreement ( Agreement ) (a) shall bind me, my family, my heirs, legal representatives, successors and assigns; (b) shall be governed by the laws of the State of Texas; and (c) shall be subject to the exclusive jurisdiction of the state and federal courts located in Potter County, Texas. PARTICIPANT HAS READ THIS AGREEMENT, FULLY UNDERSTANDS ITS TERMS, UNDERSTANDS THAT PARTICIPANT IS GIVING UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAS SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTENDS IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREES THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE VOID, VOIDABLE, INVALID OR INOPERATIVE, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT AS THOUGH SUCH VOID, VOIDABLE, INVALID OR INOPERATIVE PROVISION HAD NOT BEEN CONTAINED HEREIN. Participant s Signature (REQUIRED): Date: Name and relationship of owner(s) of horse if different from Participant:

6 PARENTAL/GUARDIAN CONSENT, AUTHORIZATION, RELEASE & INDEMNITY (PARENT/GUARDIAN MUST SIGN IF PARTICIPANT IS 17-YEARS-OLD OR YOUNGER) And I, the Participant s parent and/or legal guardian, have read this Agreement and fully understand its terms. I understand the nature of the Activities, the associated Risks of the Activities and the Participant s experience and capabilities and represent that the Participant is qualified, in good health and in proper physical condition to participate in such Activities. I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES INCURRED AS A RESULT OF THE PARTICIPANT S PARTICIPATION IN THE ACTIVITIES. I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE THE RELEASEES FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES WHENEVER OR HOWEVER ARISING AS TO INJURY, DEATH AND/OR PROPERTY DAMAGE OCCURRING AS A RESULT OF PARTICIPANT S PARTICIPATION IN THE ACTIVITIES OR CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I agree to indemnify, hold harmless and defend RELEASEES at my expense, from any and all liability, whenever or however arising, from all third party claims, demands, causes of action, suits, judgments, liabilities, costs and expenses of any nature arising out of (i) Participant s negligent act(s) or omission(s) during or related in any way to the Activities; and/or (ii) Participant s willful act(s) or omission(s) during or related in any way to the Activities; and/or (iii) any misinformation or misrepresentations made by the Participant or me in this Agreement. I agree to pay any of RELEASEES costs, expenses and reasonable attorney fees incurred, arising directly or indirectly out of or with respect to any third party claims or associated with the enforcement of the indemnity obligations referenced above. Should the Participant not abide by the established rules of conduct and I am not in attendance at the L1CS, I understand that the Participant will be returned home, and I agree to pay for the necessary transportation expenses for the Participant and the accompanying chaperone. I authorize those in charge of the delegation to make medical arrangements for the care of the Participant as deemed necessary. I further authorize any licensed medical person/facility to treat the Participant. I agree to assume full financial responsibility for any medical services provided. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. ALL INFORMATION BELOW IS REQUIRED Parent/Guardian Signature*: Date: Printed Name of Parent/Guardian: Address: Home Phone: Work Phone: Cell Phone: *If Legal Guardian, court-issued documentation must accompany entry if not already on file with AQHA NO EXCEPTIONS.