Entry Form CCC

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ENTRY FORM BEGINNER and OPEN SHOW DRIVING EVENT 9TH 10TH FEBRUARY, 2013 HOSTED BY CABOOLTURE CARRIAGE

E CLUB Address: Caboolture Pony Club Grounds Williams Road, Caboolture

Entries close: 1st February, 2013 Saturday, $25, Sunday, $25, Week-end, $40. One Activity Membership Available $25, plus entry Send entries to: H. Baskerville, 64 Hill Rd. Mothar Mountain Enquires: Helen 54835121, Class Name Horse Height OAM Total

If junior what age


ACDS affiliated club: following standards AS/NZS 3838, European Standard EN 1384, United States Standard ASTN F 1163 yes. No . Membership No..

Do all helmets being used on your carriage comply with one of the

Dont forget to bring your signed Horse Declaration Form with you
OMA- one activity membership. ALL PARTICIPANTS MUST SIGN Nomination will not be accepted without participants payment, signature. I accept responsibility for myself and all my grooms and assistants at this event. I recognise that there is an inherent risk associated with horse activities and hereby release to the full extent permitted by law the ACDS Qld Branch, the ACDS and the Caboolture Carriage Club Inc., the servants, agents, employees, officials and stewards from all claims and demands, damages, costs and expenses of every kind resulting from any accident, damages, loss or injury however caused. In accordance with the requirements as set down in the ACDS insurance, each ACDS member agrees to pay the excess which applies to any insurance claim which may arise from their participation in this event. I agree to names and photographs of myself, my grooms, assistants and/or my horse being used as publicity for the Caboolture Carriage Club Inc. or the ACDS Qld Branch. I have read and agree to comply with the conditions as specified. Signature.. Date.

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