Welcome to the ON-LINE Entry form for the Pine Rock Farm/WHOA 2017 Show Series. There should be only ONE FORM PER HORSE.  Check the button beside the date for the show you are attending during THIS registration:

Show Dates--PICK 1 for this Registration:
April 1, 2017 May 6, 2017 September 23, 2017

All I will be attending all of the Pine Rock Show Series

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An OPEN Check AND a Current Coggins MUST be left at the show office before an entry packet will be released.

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HORSE INFORMATION

Name of Horse (no nicknames please):

Gender(Pick One):

Age:

Foal Date (mm/dd/yyyy):

Breed of Horse (Pick One):

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OWNER INFORMATION

Owner's Name (FirstName Last Name):

Owner's Address:

Owner's City:

Owner's State, Zip:

Telephone Number (Home):

Telephone Number (Mobile):

E-Mail Address: (Your conformation will come to this email)

WHOA Membership Number:

WHOA Membership Designation (Pick One): ------------------------------------------------------------------------------------------------------------------------------

TRAINER INFORMATION

Trainer's Name:

Trainer's Address: 

Trainer's City:

Trainer's State, Zip: 

Trainer's Stable/Farm Name:

Trainer's Telephone Number:

Trainer's E-Mail Address:

Trainer's WHOA Membership Number:

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EXHIBITOR 1 INFORMATION

Exhibitor 1 Name:

Exhibitor 1 Address:

Exhibitor 1 City:

Exhibitor 1 State, Zip:

Exhibitor 1 Telephone (Home):

Exhibitor 1 Date of Birth (Youth Only): (mm/dd/yyyy)

Exhibitor 1 WHOA Membership Number:

Exhibitor 1 WHOA Show Status (Pick One):

Exhibitor 1 Classes Entered (Example 2,10,33):

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EXHIBITOR 2 INFORMATION

Exhibitor 2 Name:

Exhibitor 2 Address:

Exhibitor 2 City:

Exhibitor 2 State, Zip:

Exhibitor 2 Telephone (Home):

Exhibitor 2 Date of Birth (Youth Only): (mm/dd/yyyy)

Exhibitor 2 WHOA Membership Number:

Exhibitor 2 WHOA Show Status (Pick One):

Exhibitor 2 Classes Entered (Example 2,10,33):

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EXHIBITOR 3 INFORMATION

Exhibitor 3 Name:

Exhibitor 3 Address:

Exhibitor 3 City:

Exhibitor 3 State, Zip:

Exhibitor 3 Telephone (Home):

Exhibitor 3 Date of Birth (Youth Only): (mm/dd/yyyy)

Exhibitor 3 WHOA Membership Number:

Exhibitor 3 WHOA Show Status (Pick One):

Exhibitor 3 Classes Entered (Example 2,10,33):

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EXHIBITOR 4 INFORMATION

Exhibitor 4 Name:

Exhibitor 4 Address:

Exhibitor 4 City:

Exhibitor 4 State, Zip:

Exhibitor 4 Telephone (Home):

Exhibitor 4 Date of Birth (Youth Only): (mm/dd/yyyy)

Exhibitor 4 Address:

Exhibitor 4 WHOA Show Status (Pick One):

Exhibitor 4 Classes Entered (Example 2,10,33):

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FEE INFORMATION

DQP Fee (per horse):

All Show Fee (ONE horse/rider combination) Pre-Entry:

All Show Fee (ONE per horse/rider combination) Post-Entry:

Individual Class Fees (for individual or multiple riders) Pre-Entry: $15.00 per class

Individual Class Fees (for individual or multiple riders) Post-Entry: $20.00 per class

WHOA Show Card (if you are NOT an WHOA member) Required:

(Show Card Info:  $20.00 per show or $60.00 for 2017 WHOA show season)

Show Card Status (Pick One):

WHOA memberships will be available at the show. ______________________________________________________________________________

Every Entry shall constitute an agreement that the person making it, owners, exhibitors, lessee, trainer, manager, agent, coach, rider and the horse shall be subject to the bylaws and the Rules of the WHOA and the local rules of the show.  Further, it shall constitute a declaration that the horse and/or rider is eligible as entered and that the owner and all of his/her representatives are bound by the bylaws and Rules of the WHOA and the show and accept as final the decision of the WHOA on any question arising under the Rules, and agree to hold the show, the WHOA, their officials, directors and employees harmless for any action taken.

Signature of Owner/Agent:________________________________________________________  

Signature of Parent/Guardian, if youth rider:___________________________________________  

SIGNATURES WILL BE REQUIRED BEFORE AN ENTRY PACKET WILL BE RELEASED.