Hunter and Equitation Registration January 22nd – Beginning 9am Hunter and Equitation-` 1/22/2023 Show Release 1/22/23 Rider Name * Parent/Guardian if rider is under 18 Phone Number * Email * Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Emergency Contact Emergency Phone # Horse Name * Trainers Name Leadline Leadline Whole Division Leadline – Walk Leadline – Walk /Trot Leadline – Off Lead Advanced Leadline Advanced Leadline – Whole Division – Advanced Leadline – Walk Advanced Leadline – Walk/Halt Advanced Leadline – Walk/Trot Long Side Walk, Trot, Individual Canter Division Walk, Trot, Individual Canter – Whole Division Walk, Trot, Individual Canter – Walk/trot Walk, Trot, Individual Canter – Walk/Trot/ Ind Canter Walk, Trot, Individual Canter – 4 ground poles Pre-Short Stirrup Division Pre-Short – Whole Division Pre-Short – Walk Pre Short – Walk/Trot Pre-Short – 2 Trot poles Walk Trot Division W/T – Whole Division W/T – Walk, Trot/Jog – Equitation W/T – Walk, Trot/Jog – Pleasure W/T – Walk Trot/Jog 4 cross rails (trotting allowed) or Pattern Short Stirrup Division Short – Whole Division Short – Walk /Trot Short – Walk/Trot /Canter Short – 4 crossrails Beginner Rider Division Beginner Rider – Whole Division Beginner Rider – Walk/Trot Beginner Rider – Walk/Trot/Canter Beginner Rider – Crossrails Crossrail Hunter Division Crossrail Hunter – Whole Division Crossrail Hunter – Over Fences Crossrail Hunter – Over Fences Crossrail Hunter – Under Saddle Baby Green Hunter Division Baby Green – Whole Division Baby Green – Walk, Trot Baby Green – Walk, Trot, Canter Baby Green – Over Fences Adult Rider Division Adult Rider – Whole Division Adult Rider – Walk, Trot/Jog Adult Rider – Walk, Trot/Jog, Canter/Lope Adult Rider – Over Fences or Pattern Lesson Horse Division Lesson – Whole Division Lesson – Walk, Trot/Jog Lesson – Walk, Trot/Jog, Canter/Lope Lesson – Over Fences or Pattern Pleasure Horse/Pony Division Pleasure – Whole Division Pleasure – Walk-,trot/Jog Pleasure – Walk, Trot/Jog, Canter/Lope Pleasure – Over Fences or Pattern Novice Equitation Division Novice Eq – Whole Division Novice Eq – Walk, Trot Novice Eq – Walk, Trot, Canter Novice Eq – Over Fences Modified Hunter Division Modified – Whole Division Modified – Over Fences Modified – Over Fences Modified – Under Saddle Open Equitation Division Open Eq – Whole Division Open Eq – Walk, Trot Open Eq – Walk, Trot, Canter Open Eq – Over Fences Thoroughbred Hunter Division Thoroughbred – Whole Division Thoroughbred – Over Fences Thoroughbred – Over Fences Thoroughbred – Under Saddle Hopeful Hunter Division Hopeful Hunter – Whole Division Hopeful Hunter – Over Fences Hopeful Hunter – Over Fences Hopeful Hunter – Under Saddle Line It Up Member? (choose only one) * I’m riding a Line It Up horse (for any class; lease fee+Farm Fee) I am not riding a Line It Up Horse at any time in show (Farm Fee Only) Release: I understand that horse sports may be hazardous and dangerous. I assume any and all risk of loss or injury to myself, my animals and equipment, other animals or persons, and agree to release from liability and to hold harmless Line it Up, LLC, all horse show personnel, and volunteers. WARNING: Under Pennsylvania law an equine professional and equine activity sponsor is not liable for an injury to or death of a participant in equine activities resulting from the inherent risks of equine activities. Inherent risks of equine activities includes: 1) The propensity of an equine to behave in a manner which may cause injury, harm or death to a person on or near it. 2)The unpredictability of an equine’s reaction to sounds, sudden movements, unfamiliar objects, individuals or other animals. 3)An equine’s reaction to certain natural hazards, such as surface and subsurface ground conditions. 4)A collision with other equines or objects. 5)An equine’s response to the participant’s manner of handling or controlling it or inability to handle or control it. Coggins Yes No Flu/Rino Yes No Competitor Signature(s) Signature of Competitor (18 and Over) / Signature of Guardian (under 18) * Clear Date Signed Payment ($3 fee for paypal payment included) * Pay with Paypal Pay in Person (cash, check, venmo) Total If you are human, leave this field blank. Submit
