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FOX LEA FARM JANUARY HUNTER JUMPER OPEN HORSE SHOW MAIL ENTRIES TO: FOX LEA FARM, PO BOX 400,
VENICE, FL 34284 FAX ENTRIES TO: 941-484-
BACK NUMBER
JANUARY 21 & 22, 2012 NOTE: NEW FAX NUMBER 4321 STALL RESERVATIONS: 941-809-6361
NAME OF HORSE AQHA# IF APPLIES COLOR HEIGHT AGE HORSE/PONY SEX PLEASE SEND BOTH ENTRY FORM AND STALL FEE OR FAX
TO GUARANTEE STALL RESERVATION. FAXED ENTRIES ARE
CONSIDERED A CONTRACT WHICH BINDS THE EXHIBITOR
SM MED LG
TO BE FINANCIALLY RESPONSIBLE FOR THE STALL FEE.
PLEASE CALL 3-4 DAYS IN ADVANCE TO CLOSING DATE TO
CLASSES: VERIFY WHETHER WE HAVE RECEIVED YOUR ENTIRES AND
STALL RESERVATIONS THAT YOU HAVE SENT OR FAXED.
FLORIDA SENATE BILL 1658,CHAPTER 773,“EQUINE ZERO LIABILITY STATUTE” WARNING:UNDER FLORIDA LAW,AN EQUINE ACTIVITY SPONSOR OR STABLE INFORMATION:
EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO,OR DEATH OF,A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT
RISKS OF EQUINE ACTIVITIES. STABLE WITH:
Please be aware that this form incorporates liabilities’ waiver(s); thus this document waives important legal rights. Read it carefully before signing. BY SIGNING THIS DOCUMENT I AGREE in
consideration for my participation in this Competition at Fox Lea Farm to the following: BY SIGNING THIS DOCUMENT I AGREE AND ACKNOWLEDGE that horse sports involve inherent ARE YOU INCLUDED IN THEIR STALL COUNT?
dangerous risk, and by participating in horse sports and related activities such as horse care and horse shows and the like the undersigned expressly assumes any and all risks of injury or death during or PLEASE CIRCLE: YES NO
in connection with any horse related activities at Fox Lea Farm, 800 North Auburn Road, Venice, Florida. THE UNDERSIGNED FURTHER AGREES that should any loss, injury or death suffered EMERGENCY PHONE #:
by the undersigned or the child or dependant he/she is signing on behalf of as well as their horse(s) or other pet(s) or by guests, trainers, coaches, agents, or relatives accompanying he/she while at Fox
Lea Farm that he/she by participating in horse related activities expressly assumes all responsibility for loss, injury, or death and agrees to hold Fox Lea Farm, Inc. its owners, directors, agents, WHERE ARE YOU STAYING? I.E. WHICH HOTEL,
employees and guests harmless should loss, injury, or death result, directly or indirectly, from the negligent acts or missions of Fox Lea Farm, Inc., its directors, its agents, its employees and its guests. RV ON GROUNDS, HOME
BY SIGNING THIS DOCUMENT I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer,
or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury #
TACK STALL @ $30.00 PER SHOW DAY
including broken bones, head injuries, trauma, pain, suffering, or death (“Harm”). BY SIGNING THIS DOCUMENT I AGREE to release Fox Lea Farm from all claims for money damages or
otherwise for any Harm to me or my horse and for any Harm caused by me or my horse to others, even if the Harm resulted, directly or indirectly, from the negligence of Fox Lea Farm and David and # CHOOSE MAIN BARN FOR ADD'L $10
Linda Aldrich. BY SIGNING THIS DOCUMENT I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of Fox Lea Farm and David and SHAVINGS @ $7.75 PER BAG INC. SALES
Linda Aldrich. BY SIGNING THIS DOCUMENT I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) Fox Lea Farm and David and Linda Aldrich and to hold them #_________
TX
harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse at the Competition. BY SIGNING THIS DOCUMENT I AGREE RV RESERVATION: PER NIGHT ELECTRIC & WATER ONLY,
that while I am on the show grounds and mounted on any horse or pony that I will wear protective head gear. I understand that protective head gear can not guarantee that I will not receive a trauma or 30 AMP: $37.50 / 50 AMP $47.50
injury if an accident may occur. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the DATES ATTENDING : _________________
obligations of this Release on the child’s behalf. BY SIGNING THIS DOCUMENT I AGREE that Fox Lea Farm and David and Linda Aldrich as used above includes all of their officials, officers,
directors, employees, agents, personnel, volunteers and affiliated organizations. I further agree that if any damage shall be occasioned or loss occur, by fire or otherwise, to the horses exhibited, or to PLEASE CIRCLE ONE: 30 AMP 50 AMP
any vehicle or other article that I may send with such horses that I will make no claim therefore; and I further agree to hold this competition and Fox Lea Farm, Inc. and its owners harmless from any GENERAL SHOW FEES:
claim or demand of whatsoever kind or nature, that may be occasioned by the horse or horses exhibited by me, or the negligence of the persons in charge of such horses, and to repay to this
competition, on demand, all damages it may sustain by reason of any claim or demand as aforesaid. I agree that if any damage shall be occasioned or loss occur, by fire or otherwise, to the horses NEW FLAT FEES PER DAY! PLEASE SEE SHOW
exhibited, or to any vehicle or other article that I may send with such horses that I will make no claim therefore; and I further agree to hold this competition and Fox Lea Farm, Inc. and its employees SCHEDULE FOR DETAILS. THE ECONOMICALLY
and its agents and its owners harmless from any claim or demand of whatsoever kind or nature, that may be occasioned by the horse or horses exhibited by me, or the negligence of the persons in FRIENDLY SHOW JUST GOT BETTER!
charge of such horses, and to repay to this competition, on demand, all damages it may sustain by reason of any claim or demand as aforesaid. Ultimately the final decision on whether ring conditions Master American
and weather conditions are safe for the rider, and horse/pony, belong to the trainers and exhibitors or those responsible for such decision for a minor exhibitor. I represent that I have the requisite We Honor: Visa
Card
Discover
Express
training, coaching and abilities to safely compete in this competition. BY SIGNING BELOW, I further AGREE to be bound by all applicable Fox Lea Farm Rules and all terms and provisions of this Card Number:
entry blank. BY SIGNING BELOW, I further AGREE that I have been given permission to sign this form for whomever it may include, ie. ower, rider, trainer. The format of this liability agreement
is related to the format and wording of the United States Equestrian Federation (USEF) recommended release for recognized shows, all wording related to the Federation has been altered to represent
Exp Date: Month__________ Year______
only Fox Lea Farm, Fox Lea Farm Inc., and David & Linda Aldrich for an unrecgnized competition that has no connection to the USEF. We have asked permission from USEF to use this style,
formatting and wording. If we are not granted permission to use this form we will furnish a new liability release to all entering the show grounds at the show office. Cardholders Name
Billing Address (Street/PO, City, State & zip)
MANDATORY SIGNATURES BELOW: IF UNDER THE AGE OF 18, A PARENT OR LEGAL GAURDIAN MUST SIGN Signature
OWNER (SS# MANDATORY BELOW FOR PRIZE MONEY) RIDER B-DAY MM/YY TRAINER/COACH
NAME: NAME: NAME:
ADDRESS: ADDRESS: ADDRESS:
CITY/ST/ZIP: CITY/ST/ZIP: CITY/ST/ZIP:
E-MAIL: AQHA # E-MAIL: AQHA # E-MAIL
CONTACT PHONE #: SS#: CONTACT PHONE #: HOME PHONE: CELL PHONE:
OWNER/AGENT SIGNATURE RIDER,DRIVER, OR HANDLER SIGNATURE TRAINER SIGNATURE
X X X
AGENT SIGNATURE PARENT OR LEGAL GAURDIAN SIGNATURE COACH SIGNATURE
X X X
STABLE WITH:
ARE YOU INCLUDED IN THEIR
STALL COUNT?
#_________ MAIN BARN STALL @ $165
#_________ SHOW BARN STALL @ $145
SHAVINGS @ $7.50 PER BAG
#_________
INC. SALES TX
RV RESERVATION: PER NIGHT ELECTRIC & WATER
ONLY, 30 AMP: $30.00 / 50 AMP $35.00
PLEASE CIRCLE ONE: 30 AMP 50 AMP
GENERAL SHOW FEES:
USEF FEE $7 + DRUG FEE $5: $12
SCHOOLING FEE: $25
SERVICE FEE : $30
GROUNDS FEE PER DAY: $25
JR. USEF NON-MEMBER FEE: $20, JR. USHJA NON-
MEMBER FEE: $20
SEN. USEF NON-MEMBER FEE: $25, SEN. USHJA
NON-MEMBER FEE: $20
COMPLETE ENTRIES REC'D BY CLOSE DATE INC.
USEF #S, CLASS #S, FULL ADDRESSES: $10 CREDIT
Sheet2
Federation Entry Agreement: I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR1502.4) as printed in
the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold
Page 3
Sheet2
ion, Inc. (the “Federation”) Entry Agreement (GR1502.4) as printed in the Prize List for this Competition and agree to all of its provisions. I understand and agree
r costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by ot
Page 4
Sheet3
Federation Entry Agreement: I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR1502.4) as printed in
FEDERATION ENTRY AGREEMENT: By entering a Federation-recognized Competition and signing this entry blank as the Owner, Lessee, Trainer,
I AGREE in consideration for my participation in this Competition [insert name] to the following:
I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent
Page 5
Sheet3
Entry Agreement (GR1502.4) as printed in the Prize List for this Competition and agree to all of its provisions. I understand and agree that by entering this Comp
ntry blank as the Owner, Lessee, Trainer, Manager, Agent, Coach, Driver, Rider, Handler, Vaulter or Longeur and on behalf of myself and my principals, represent
dler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and t
Page 6
Sheet3
tand and agree that by entering this Competition, I am subject to Federation Rules, the Prize List, and local rules of the competition. I agree to waive the right to t
half of myself and my principals, representatives, employees and agents, I agree that I am subject to the Bylaws and Rules of The United States Equestrian Federa
e and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, h
Page 7
Sheet3
competition. I agree to waive the right to the use of my photos at the competition, and agree that any actions against the Federation must be brought in New York
es of The United States Equestrian Federation, Inc. (the “Federation”) and the local rules of the competition. I agree to be bound by the Bylaws and Rules of the F
us bodily injury including broken bones, head injuries, trauma, pain, suffering, or death (“Harm”). I AGREE to release the Federation and the Competition from all
Page 8
Sheet3
e Federation must be brought in New York State. The complete statement is as follows:
be bound by the Bylaws and Rules of the Federation and of the competition. I will accept as final the decision of the Hearing Committee on any question arising u
e Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm caused by me or my horse to
Page 9
Sheet3
aring Committee on any question arising under the Rules, and agree to release and hold harmless the competition, the Federation, their officials, directors and em
for any Harm caused by me or my horse to others, even if the Harm resulted, directly or indirectly, from the negligence of the Federation or the Competition. I AG
Page 10
Sheet3
Federation, their officials, directors and employees for any action taken under the Rules. I represent that I am eligible to enter and/or participate under the rules, a
of the Federation or the Competition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Fed
Page 11
Sheet3
enter and/or participate under the rules, and every horse I am entering is eligible as entered. I also agree that as a condition of and in consideration of acceptanc
m resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federat
Page 12
Sheet3
ition of and in consideration of acceptance of entry, the Federation and/or the compet
amages, or costs incurred by) the Federation and the Competition and to hold them
Page 13
Sheet5
FOX LEA FARM APRIL "C" SHOW - APRIL 22 & 23, 2006 - ENTRIES CLOSE - MAIL ENTRIES TO:
APRIL 15, 2006 FOX LEA FARM, PO BOX 400,
BACK NUMBER VENICE, FL 34284
USA EQ. FEE $7 + DRUG FEE $5: $12
SCHOOLING FEE: $15
SERVICE FEE : $15
GROUNDS FEE PER DAY: $25
NON-SHOWING HORSE FEE: $40
USAE DISCIPLINE OR AFFIDAVI: $5
SEN. NON-MEMBER FEE(20): (+ Disc Fee): $25
JUNIOR NON-MEMBER FEE: $20
30 AMP RV SPACE PER NIGHT 28.00, 50 AMP 33.00
Page 14
Sheet5
MAIL ENTRIES TO: STABLE WITH:
FOX LEA FARM, PO BOX 400, FAX ENTRIES TO: 941-484-8245 #____ MAIN BARN STALL @
VENICE, FL 34284 PLEASE SEND BOTH ENTRY FORM AND STALL FEE OR FAX TO GAURANTEE STALL FEE #____ SHOW BARN STALL
Page 15
Sheet5
MAIN BARN STALL @ $85
SHOW BARN STALL @ $75
Page 16
