Xhalt Equestrian Center Schooling Show Entry Form

                                   (One Entry Per Rider/Horse Combination)   

Please Print

Rider’s Name:______________________________Show Date________

Address:______________________________________

              ______________________________________

Please provide an E-Mail__________________________

Phone (Day)___________________(Night)_________________

Trainer______________________  

Check one:

____Professional     ______Amateur    _____Junior (Must have guardian’s

                                                                                        signature below)

Horse’s Name:______________________________

Coggins Test Date:________________Attach a copy of horse’s coggins with entry form.

Please circle the classes that you wish to enter:

Fee $30.00 per class                                            

Make check payable to:  Xhalt Equestrian Center.     

Mail to:                            14479 South Island Road

                                         Columbia Station, Ohio  44028

As a condition of entry into the Schooling Show the access to the Show Grounds, I, the undersigned, do
hereby waive all claims against Xhalt Equestrian Center Inc., its employees, the judge, and volunteers
for any lost, stolen, or damaged articles and further hold no liability for any injury sustained by any
horse, participant, spectator, or volunteer. 

Participant Signature___________________________Date___________

If the participant is a minor:

I have read the above condition of entry and do hereby consent and agree that__________________
(a minor for which I have legal guardianship) may participate in the Xhalt Equestrian Center schooling show.

Parent/Guardian Signature_______________________Date___________

SHOW INFORMATION: www.xhalteqcenter.com or call 216-299-3069