2019 NWHA Texas Gaited Rumble Regional Championship Horse Show
June 28-29, 2019 Extraco Event Center, Waco, TX
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Current NWHA Membership or NWHA Temp Card required to show.
Person Responsible for bill on these horses.
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Owner full name:
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Owner address:
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Owner city, state, zip
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Owner NWHA number:
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Does the owner need an NWHA Membership or NWHA Temp Card?
Owner phone:
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Owner cell phone:
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Owner farm/ranch/stable name:
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Owner E-mail
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Trainer name:
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Trainer full name:
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Trainer full address (include city, state, zip)
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Trainer phone:
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Trainer cell phone:
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Trainer Farm/Stable/Ranch:
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Trainer NWHA number:
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Does the trainer need an NWHA Membership or NWHA Temp Card?
Trainer E-mail:
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Horse A - Name:
Horse A
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Horse A - Breed
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Horse A - Registraion #
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Horse A - Foal Date
MM
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DD
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YYYY
Horse A - Sex
Horse A - COGGINS - Owner on coggins
MUST SUBMIT COPY OF COGGINS AT CHECK IN!
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Horse A - COGGINS - Horse name on coggins
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Horse A - COGGINS - Accession Number
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Horse A - COGGINS - Date Blood Drawn
MM
/
DD
/
YYYY
Horse A - COGGINS - Laboratory
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Horse B - Name:
Horse B
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Horse B - Breed
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Horse B - Registraion #
Your answer
Horse B - Foal Date
Your answer
Horse B - Sex
Horse B - COGGINS - Owner on coggins
MUST SUBMIT COPY OF COGGINS AT CHECK IN!
Your answer
Horse B - COGGINS - Horse name on coggins
Your answer
Horse B - COGGINS - Accession Number
Your answer
Horse B - COGGINS - Date Blood Drawn
MM
/
DD
/
YYYY
Horse B - COGGINS - Laboratory
Your answer
Horse C - Name:
Horse C
Your answer
Horse C - Breed
Your answer
Horse C - Registraion #
Your answer
Horse C - Foal Date
Your answer
Horse C - Sex
Horse C - COGGINS - Owner on coggins
MUST SUBMIT COPY OF COGGINS AT CHECK IN!
Your answer
Horse C - COGGINS - Horse name on coggins
Your answer
Horse C - COGGINS - Accession Number
Your answer
Horse C - COGGINS - Date Blood Drawn
MM
/
DD
/
YYYY
Horse C - COGGINS - Laboratory
Your answer
Exhibitor A Full Name
Exhibitor A
Your answer
Exhibitor A Full Address (include city, state, zip)
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Exhibitor A Adult or Youth
Exhibitor A DOB (IF YOUTH)
MM
/
DD
/
YYYY
Exhibitor A NWHA Number:
Your answer
Does the Exhibitor A need an NWHA Membership or NWHA Temp Card?
Exhibitor A Phone Number:
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Exhibitor A Classes for HORSE A: (example 1, 5, 22, 96...)
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Exhibitor A Classes for HORSE B: (example 1, 5, 22, 96...)
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Exhibitor A Classes for HORSE C: (example 1, 5, 22, 96...)
Your answer
Exhibitor A E-mail:
Your answer
Exhibitor B Full Name:
Exhibitor B
Your answer
Exhibitor B Full Address (include city, state, zip):
Your answer
Exhibitor B Adult or Youth:
Exhibitor B DOB (IF YOUTH)
MM
/
DD
/
YYYY
Exhibitor B NWHA Number
Your answer
Does the Exhibitor B need an NWHA Membership or NWHA Temp Card?
Exhibitor B Phone Number
Your answer
Exhibitor B E-mail:
Your answer
Exhibitor B Classes for HORSE A: (example 1, 5, 22, 96...)
Your answer
Exhibitor B Classes for HORSE B: (example 1, 5, 22, 96...)
Your answer
Exhibitor B Classes for HORSE C: (example 1, 5, 22, 96...)
Your answer
Exhibitor C Full Name:
Exhibitor C
Your answer
Exhibitor C Full Address (include city, state, zip):
Your answer
Exhibitor C Adult or Youth:
Exhibitor C DOB (IF YOUTH
MM
/
DD
/
YYYY
Exhibitor C NWHA Number:
Your answer
Does the Exhibitor C need an NWHA Membership or NWHA Temp Card?
Exhibitor C Phone Number:
Your answer
Exhibitor C E-mail:
Your answer
Exhibitor C Classes for HORSE A: (example 1, 5, 22, 96...)
Your answer
Exhibitor C Classes for HORSE B: (example 1, 5, 22, 96...)
Your answer
Exhibitor C Classes for HORSE C: (example 1, 5, 22, 96...)
Your answer
Stalls:
Bedding $10 Each - number of bags
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Camper/RV Sites $35 per day
Grounds fee - $20 per horse per day (for horse WITHOUT a stall) Horse name and how many days?
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Please consider a Sponsorship. Any amount helps us continue the show.
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Comments - Requests - Questions -
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CURRENT 12 MONTHS COGGINS REQUIRED FOR ALL HORSES ON SHOW GROUNDS
Persons on Federal Suspension shall participate at the show as spectators only. As owner, agent or guardian, I certify that the information provided on this entry form is correct and I agree to indemnify and hold harmless NWHA Texas Gaited Rumble Regional Championship Show, the Extraco Event Center, the managers and their respective agents, contractors, officers, employees, directors, shareholders and assigns from all responsibility to horses, persons, and/or equipment arising from any connection with this show. It is understood and agreed that participants will be solely responsible for any consequential or other loss, injury, or damage incurred while participating in this event. WARNING; UNDER TEXAS LAW 9 CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES. UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), A LIVESTOCK SHOW SPONSOR IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN A LIVESTOCK SHOW RESULTING FROM THE INHERENT RISKS OF LIVESTOCK SHOW ACTIVITIES. *
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