Event Derby Registration Form
Join us on Saturday, July 11, 2020 at Herron Park!
Please complete this form, print and sign the required Liability Release (https://goo.gl/O00Oyr), and send your payment (checks made out to HPE) to show secretary:

Cindy Covington124 LaDoux Drive
Kalispell, MT 59901

Payment should be postmarked or delivered by Tuesday, July 7, 2020 to avoid $15 late fee. Riders will not be given a ride time if fees are not received within two days before the show. You will need to complete one form for each horse. Make sure you click "submit" when you finish filling out the form. All proceeds from this event go to maintaining the jumps and dressage arenas at the park.

*USEF rules will apply as guidelines for all HPE events. ALL riders while mounted must wear ASTM/SEI approved helmet. Body protector vests are strongly encouraged. Every participant must sign release form or have parent/guardian sign if they are less than 18 years old.

Please contact Cindy Covington (carbonxc@me.com / 206-551-2113) with any questions or if you would like to volunteer.
Email *
Rider's Name *
Rider's Mailing Address *
Rider's Phone Number
Rider's Email
Rider's Age *
Parent/Guardian's Name
Enter N/A if rider is an adult.
Horse's Name *
Horse Owner's Name and Phone Number *
Level Competing
Individual/Additional Dressage Tests
$20/test for dressage tests only. Current tests for 2019.
Clear selection
Additional Jumping Rounds
$15/any level, just indicate the number of additional rounds requested (Must be entered in derby to add additional rounds.)
Clear selection
Are you a current FCTA member? *
$15 non-member fee or $35/individual to join or $50/family
Stall needed *
$20/stall/night payable to Flathead County Parks & Recreation
Camp site needed *
$20/night/site payable to Flathead County Parks & Recreation
Total Amount of Payment Sent *
If you are planning on camping and/or using a stall, please send a SEPARATE check made payable to Flathead County Parks and Recreation. Payment needs to be postmarked by Tuesday, July 7th to avoid the $15 late fee. *Remember to add your division ($45), additional dressage/jumping rounds, non-member fee (or new membership), and stabling/camping (separate check).
A copy of your responses will be emailed to the address you provided.
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