2024 Summer Show Series Entry Form Please enable JavaScript in your browser to complete this form.Show Date *June 12June 19July 10July 17July 31August 10 (9am start)Horse Name *Height *Small PonyMedium PonyLarge PonyHorseOwner of Horse *Rider's Name *Rider's Age *Jr. Rider 14 & underJr. Rider 15-17Adult RiderTrainerContact Email *Name or Parent/Guardian Name *FirstLastPhone Number *Address *Select Classes $18/class and $10 Office Fee1. California Warm-Up2. Leadline A 100% Rider3. Leadline B 50% Rider/50% Horse4. Leadline C 100% Rider w/ test5. Pre-Short Walk Only6. Pre-Short W/T7. Pre-Short Walk/Sit-Trot/Jump Position8. Short Stirrup Equitation W/T9. Short Stirrup Equitation W/T/C10. 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/C14. Long Stirrup Equitation W/T15. Long Stirrup Equitation W/T/C16. Long Stirrup Equitation o/ Fences (18")17. Pleasure Pony Walk/Trot18. Pleasure Pony Go-as-You-Please19. Pleasure Pony Walk/Trot/Canter20. Pony Eq. o/ Fences21. Pony/Green Pony Hunter o/ Fences Course A22. Pony/Green Pony Hunter o/ Fences Course B23. Pony/Green Pony Hunter under saddle24. Pleasure Horse Walk/Trot25. Pleasure Horse Go-as-You-Please26. Pleasure Horse Walk/Trot/Canter27. Eq on the Flat28. Low/Schooling Hunter o/ Fences Course A29. Low/Schooling Hunter o/ Fences Course B30. Low/Schooling Hunter under saddleSchooling ONLY Prior to show start $18.00 FeeIf entered in classes Low/Schooling Hunter please specify desired jump heightLow Jump Height 2' and Schooling Jump Height 2'6"COVID-19 Notice:COVID-19 Notice: We have taken enhanced health and safety measures, for you, our other exhibitors and Staff. You must follow all posted instructions while on these showgrounds. They are from the VHSA, the BHSA and this show. An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and Guests with underlying medical conditions are especially vulnerable. By visiting this Horse Show you voluntarily assume all risks related to exposure to COVID-19. The following procedures are strongly recommended: The wearing of masks; social distancing; wearing of gloves; only essential personnel present-grooms, trainers, riders, owners and one parent per junior rider except Leadline and Pre-Short Stirrup (2 parents); no spectators; online/pre-entries when possible; limited numbers in Show Office; picking up ribbons rather than person-to-person most times; controlled food service. Entries must be complete with all signatures. Bring your current copy of your Coggins to the show, it must be a hard copy that the show can keep. Please have an open check or cash when registering/picking up numbers. No credit cards. Remember, face masks are recommended on everyone, even riders, except when mounted. If a rider wishes to compete wearing a mask, there will be no penalty. At ringside, remember to maintain social distancing. If coming to the show, you must be able to assure management that neither you, nor anyone in your household or group has tested positive or has been presumed positive for COVID-19 within the past 14 days; has been advised by a healthcare professional to self-quarantine within the past 14 days; has been in close physical contact with someone who has tested positive for COVID-19 or been presumed positive within the past 14 days; is subject to a quarantine order or recommendation of a healthcare professional that in either case would make it inadvisable to attend a show; has within the past 24 hours exhibited any symptoms including fever of 100.4 or greater, cough, shortness of breath. We are all in this together and all need to do their part to make the day safe for everybody. 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.NameSubmit