2017 Halloween Dressage, CT & Jumper Show Entry Form ON LINE ENTRY FORM Horse:*Owner Name* First Last Rider Name*Same as ownerDifferent than ownerRider's Name (if different than owner) First Last Rider's Age*Under 18Over 18Rider's Level*OpenJR/YRAAAre you a current member of TVDCTA?*YesNoNon-member fee Price: $20.00 TVDCTA Group Member # (optional):Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Date of Coggins* Upload Copy of Coggins Test*Accepted file types: jpg, pdf, doc.Interested in Volunteering?YesNoSelect ClassesDressage OnlyPlease note that all dressage tests are full. Any entries received after 10/13/16 for dressage will be put on a wait list. You will be emailed if a spot becomes available. (there are still a few jumper classes and clinic spots open).Dressage TestsIntro Level A Intro Level AA/O Intro Level A - JR/YR Intro Level B Intro Level B - AA/O Intro Level B - JR/YR Intro Level C Intro Level C - AA/O Intro Level C- JR/YR Training Level 1 Training Level 1 - AA/O Training Level 1-JR/YR Training Level 2 Training Level 2 - AA/O Training Level 2- JR/YR Training Level 3 Training Level 3 - AAA/O Training Level 3- JR/YR First Level Test 1 First Level Test 1 - AA/O First Level Test 1- JR/YR First Level Test 2 First Level Test 2 - AA/O First Level Test 2- JR/YR First Level Test 3 First Level Test 3 - AA/O First Level Test 3- JR/YR Second Level Test 1 Second Level Test 1 - AA/O Second Level Test 1- JR/YR Second Level Test 2 Second Level Test 2 - AA/O Second Level Test 2- JR/YR Second Level Test 3 Second Level Test 3 - AA/O Second Level Test 3- JR/YR Third Level Test of Choice (TOC) Third Level TOC - AA/O Third Level TOC - JR/YR Specify TestFourth Level TOC Fourth Level TOC - AA/O Fourth Level TOC - JR/YR Specify TestFEI TOC FEI TOC - AA/O FEI TOC - JR/YR Specify TestSpecify TestUSEA TOC USEA TOC - AA/O USEA TOC - JR/YR Specify TestCIC/CCI TOC CIC/CCI TOC - AA/O CIC/CCI TOC - JR/YR Specify TestCombined TrainingCombined TrainingAmoeba Amoeba (USDF Intro A, 18") - AA/O Amoeba (USDF Intro A, 18") - JR/YR Tadpole Tadpole (USDF Intro B, 2') - AA/O Tadpole (USDF Intro B, 2') - JR/YR Starter Starter (USDF Intro C, 2'3") - AA/O Starter (USDF Intro C, 2'3") - JR/YR Beginner Novice Beginner Novice (USEA BN Test A, 2'7") - AA/O Beginner Novice (USEA BN Test A, 2'7") - JR/YR Novice Novice (USEA Novice Test A, 2'11") - AA/O Novice (USEA Novice Test A, 2'11") - JR/YR Training Training (USEA Training Test A, 3'3") - AA/O Training (USEA Training Test A, 3'3") - JR/YR Preliminary Preliminary (USEA Prelim Test A, 3'7") - AA/O Preliminary (USEA Prelim Test A, 3'7") - JR/YR Jumper ClassesJumper ClassesPuddle Jumpers Puddle Jumpers (18") - AA/O Puddle Jumpers (18") - JR/YR -------Add Schooling Round Schooling Jumpers Schooling Jumpers (2') - AA/O Schooling Jumpers (2') - JR/YR -------Add Schooling Round Green Jumpers Green Jumpers (2'3") - AA/O Green Jumpers (2'3") - JR/YR -------Add Schooling Round Hopeful Jumpers Hopeful Jumpers (2'7") - AA/O Hopeful Jumpers (2'7") - JR/YR -------Add Schooling Round Training Jumpers Training Jumpers (2'9") - AA/O Training Jumpers (2'9") - JR/YR -------Add Schooling Round Working Jumpers Working Jumpers (3') - AA/O Working Jumpers (3') - JR/YR -------Add Schooling Round Open Jumpers Open Jumpers (3'3") - AA/O Open Jumpers (3'3") - JR/YR -------Add Schooling Round Mini Prix Jumpers Mini Prix (3'6") - AA/O Mini Prix (3'6") - JR/YR -------Add Schooling Round ClinicsPlease specify the test to be ridden or the level desired for the ClincPrivate Dressage Price: $175.00 Quantity: Sat/SunTest to be riddenPrivate Jump Clinic Price: $175.00 Quantity: Sat/SunLevel to rideSmall Group (2-4) Jump Price: $125.00 Quantity: SundayLevel to rideConvenience Fee* Price: $2.00 Total $0.00 Release of LiabilityIn making this application and entering in equine activities at Flint Ridge Farm, the undersigned agrees and acknowledges that participating in equine activities may result in injuries or death as a result of the inherent risk of equine activities. The undersigned on behalf of herself or himself and as the parent or guardian of any minor entered does herby agree to assume any and all risks, known or unknown, associated with all equine activities held at, or sponsored by, Flint Ridge Farm and TVDCTA. The under- signed on behalf of herself or himself, and as the parent or guardian of any minor entered does further agree to indemnify and hold harmless TVDCTA, Flint Ridge Farm and its employees, agents, volunteers and officers from any and all damages and losses, whether known or unknown, occurring to any person, horse, pony, vehicle or property, of the undersigned or any minor that the undersigned is a parent or guardian for.Rider Signature (or Parent/Guardian if under 18)*Printing your full name will act as a signature to indicate that you agree to the terms of the Release of Liability above.Date This iframe contains the logic required to handle Ajax powered Gravity Forms.