2025 Summer Show Series Entry Form

Show Date *

Horse Name *

Height *

Owner of Horse *

Rider's Name *

Rider's Age *

Trainer

Contact Email *

Name or Parent/Guardian Name *

First

Last

Phone Number *

Address *

Select Classes $20/class and $10 Office Fee

1. California Warm-Up
2. Leadline A 100% Rider
3. Leadline B 50% Rider/50% Horse
4. Leadline C 100% Rider w/ test
5. Pre-Short Walk Only
6. Pre-Short W/T
7. Pre-Short Walk/Sit-Trot/Jump Position
8. Short Stirrup Equitation W/T
9. Short Stirrup Equitation W/T/C
10. Short Stirrup Equitation o/ Fences (18”)
11. Short Stirrup Hunter o/ Fences Course A (18")
12. Short Stirrup Hunter o/ Fences Course B (18")
13. Short Stirrup Hunter W/T/C
14. Long Stirrup Equitation W/T
15. Long Stirrup Equitation W/T/C
16. Long Stirrup Equitation o/ Fences (18")
17. Pleasure Pony Walk/Trot
18. Pleasure Pony Go-as-You-Please
19. Pleasure Pony Walk/Trot/Canter
20. Pony Eq. o/ Fences
21. Pony/Green Pony Hunter o/ Fences Course A
22. Pony/Green Pony Hunter o/ Fences Course B
23. Pony/Green Pony Hunter under saddle
24. Pleasure Horse Walk/Trot
25. Pleasure Horse Go-as-You-Please
26. Pleasure Horse Walk/Trot/Canter
27. Eq on the Flat
28. Low/Schooling Hunter o/ Fences Course A
29. Low/Schooling Hunter o/ Fences Course B
30. Low/Schooling Hunter under saddle
Schooling ONLY Prior to show start $18.00 Fee

If entered in classes Low/Schooling Hunter please specify desired jump height

Low Jump Height 2' and Schooling Jump Height 2'6"

Participant/Parent or Guardian* Signature/Date for Equine Activity Release Waiver, Assumption of Risk & Identification Agreements & Notification of Risks. *

In consideration of my child’s/my participation in any equine activity with Picturesque Farm, LLC at 7769 Piccadilly Drive, Warrenton, VA. I hereby release and waive any rights to legal action against Picturesque Farm, LLC, Kristy Willwerth, Sandra Willwerth, employees, agents, and representatives of either the LLC or the farm for any loss, dam age, injury, or death to the person or property sustained by myself or child in any equine activities by any cause whatsoever, including but not limited to any risk inherent in an equine activity, such as (1) The propensity of an equine to behave in dangerous ways which may result in injury or death to a participant or bystander, damage to property (2) The inability to predict an equine’s reaction to sound, movements, conditions, objects, persons, or animals (3) Hazards of surface or of subsurface conditions whether known or unknown (4) The experience level or any participant (5) A known or unknown health condition of any participant (6) The condition and age of tack and equipment. I assum e all of the forgoing risks and any other risks inherent in equine activities and accept com plete responsibility for making any and all examinations or inspections relating to those risks and other potential risks of recreational activities and I agree and understand that Picturesque Farm LLC, Kristy Willwerth and Sandra Willwerth shall have no responsibility whatsoever to make any such examination or inspection. I further assume all risk of, and agree to hold harmless the LLC owner, farm owners, their employees, representatives, and agents from and against, any and all loss, dam age, injury, or death to person or property, by whatever cause, including: any act of omission, negligent or otherwise, on the part of the farm or LLC owners, their employees, representatives, or agents or on the part of any other person. I hereby certify that the foregoing statem ents and representation are being made knowingly, freely, and voluntarily and I understand that Kristy, Sandy and Picturesque Farm LLC, are expressly relying upon the foregoing statement and representations in permitting me/my child’s participation in any equine activities.