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Only one horse/pony per entry form. Rider s Age as of 12/1/2011 Rider s Address City State Zip Rider s Phone xxx-xxx-xxxx Rider s E-mail Parent/Guardian s Name if rider is a Junior Horse or Pony s Name Coggins Test Pony size Sm / Med / Lg Entry Trainer s Name Owner s Name Classes Entered Enter online at www. YORK COUNTRY DAY SCHOOL 15th ANNUAL HORSE SHOW Sunday May 20 2012 Pre-enter by Friday May 18th at Noon* Rider s Name No fee to scratch Entry. ycpalumni. com/YCDSHorseShow Total of Classes Entered X 12 Email entries to horseshow ycds. org Office Fee 10 per entry FAX entries to 847-953-0431 Post-entry Fee additional 10 after 5/18 Rebecca Kinsley 2975 Markle Road York PA 17408 10 TOTAL FEES DUE Make Checks Payable to YCDS Horse Show There will be a 25 returned check fee. Warning In accordance with PA Act 93 of 2005 you assume the risk of Equine Activities Pursuant to Pennsylvania Law. Name Rider s Release The undersigned individually and as a parent and guardians of any minor assumes all risks involved with participation in the York Country Day School Benefit Horse Show held at South Branch Farms. I agree to release discharge and hold harmless York Country Day School York College of Pennsylvania South Branch Farms Rebecca Kinsley Elizabeth A. Dolmetsch Robert A. Kinsley and/or any employees officers or causes liabilities damages claims and demand on account of personal injury accident or property damage incurred on or off horse show grounds. I also acknowledge that I am fully aware of the normal hazards encountered in such a horse show to persons property ponies or horses. I have read understand and agree with the above. Name of responsible adult Signature Relationship to Rider. ycpalumni. com/YCDSHorseShow Total of Classes Entered X 12 Email entries to horseshow ycds. org Office Fee 10 per entry FAX entries to 847-953-0431 Post-entry Fee additional 10 after 5/18 Rebecca Kinsley 2975 Markle Road York PA 17408 10 TOTAL FEES DUE Make Checks Payable to YCDS Horse Show There will be a 25 returned check fee. Warning In accordance with PA Act 93 of 2005 you assume the risk of Equine Activities Pursuant to Pennsylvania Law. Warning In accordance with PA Act 93 of 2005 you assume the risk of Equine Activities Pursuant to Pennsylvania Law. Name Rider s Release The undersigned individually and as a parent and guardians of any minor assumes all risks involved with participation in the York Country Day School Benefit Horse Show held at South Branch Farms. Name Rider s Release The undersigned individually and as a parent and guardians of any minor assumes all risks involved with participation in the York Country Day School Benefit Horse Show held at South Branch Farms. I agree to release discharge and hold harmless York Country Day School York College of Pennsylvania South Branch Farms Rebecca Kinsley Elizabeth A. I agree to release discharge and hold harmless York Country Day School York College of Pennsylvania South Branch Farms Rebecca Kinsley Elizabeth A. Dolmetsch Robert A. Kinsley and/or any employees officers or causes liabilities damages claims and demand on account of personal injury accident or property damage incurred on or off horse show grounds.

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