Schooling Dressage Show
White Rose Equestrian, 1966 Magnolia Grove Road, Iron Station, NC 28080
(704) 559-9122
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Date of event *
Rider's Name *
Jr./Sr. *
Age if under 18
Amateur/Professional *
Street Address
Town/City
State
Zip
Email *
Phone Number *
Horse/Pony's Name *
Tests to be ridden ($35 per class) *
Total money owed ($35 per class) *
Method of payment *
Coggins *
NOTICE: All entrants participate at their own risk and must complete an Equine Activities Waiver. This form can be found on our website at www.whiteroseequestrian.com/forms or completed on the day of the event. In the event of an emergency: By completing this form I understand that horseback riding and equestrian related activities can be dangerous. I hereby give permission that I, or my minor child/charge, maybe administered first aid by any representative of White Rose Equestrian should the need arise. I also give permission that I, or my minor child/charge, may be transported to a hospital chosen by any White Rose Equestrian representative, treated by a medical professional, given injections, medication, and/or anesthesia and/or surgery as deemed necessary. I agree to be responsible for any cost that may occur as a result of being treated for any medical condition. *
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