Pirouette Farm, Inc.

Dressage Show

ENTRY FORM

           Rider’s name: ___________________________________________________________

           Address:         ___________________________________________________________

           City, State, Zip Code: _____________________________________________________

           Phone number: __________________________________________________________

           Email address: ___________________________________________________________

           Horse’s name: ___________________________________________________________

          EMERGENCY CONTACT & PHONE NUMBER:______________________________

CLASS#              DESCRIPTION                                  FEE                         ARENA SIZE?

I understand that equine activities are considered a high risk sport and enter this show at my own risk.  I agree to hold harmless and indemnify

Pirouette Farm, Inc., its employees, volunteers, representatives, agents, and the property owner from all liability and/or negligence due to loss, damage,

injury, accident, illness, or death to myself, my agents, my property or my horses during this show.

WARNING:  Under Vermont law, an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from

the inherent risks of equine activities that are obvious and necessary, pursuant to 12 V.S.A. section 1039. (Vermont Statutes Title 12, Chapter 27,

Subchapter 2, section 1039)

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Rider’s signature

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Parent/Guardian signature if competitor is under 18 years of age

Send Entries to: Mary Piro, Pirouette Farm, 96 Hogback Rd, Norwich, VT  05055   www.pirouettefarm.com